Of the 1,845 consecutive patients with CAD who received PCI/CABG, 590 (31.9%) exhibited depression/anxiety and 205 agreed to undergo the mental stress test. The mean age of the participants was 59.72 years (standard deviation [SD], 10.1), and 64 (31.2%) were women. The mental stress test was performed subsequent to an average follow-up of 42.8 days (SD, 46.1) after coronary revascularization.
Overall, 105 (51.2%) patients developed MSIMI. Among them, 59 (56.2%) had reversible myocardial perfusion defects, 30 (28.6%) had an EF reduction of ≥5%, 27 (25.7%) had TID, and 13 (12.4%) had reverse redistribution. Furthermore, 82 patients had only one abnormal phenomenon, 22 patients displayed a combination of two abnormal phenomena, and 1 patient exhibited three abnormal phenomena. The baseline characteristics of the 205 patients in the MSIMI and non-MSIMI groups are shown in Table 1. There were no significant differences between the two groups in the demographic risk factors as well as the angiographic severity of CAD. However, the MSIMI group demonstrated significantly higher PHQ9 scores at baseline, and the non-MSIMI group had a greater percentage of drinking history.
At rest, left ventricle EDV and ESV were lower in the MSIMI group than in the non-MSIMI group (79.2 ± 30.1 vs. 92.7 ± 44.1 and 30.1 ± 21.7 vs. 40.4 ± 34.8, respectively, P < 0.05). Furthermore, EF was higher in the MSIMI group than in the non-MSIMI group (64.8 ± 12.8 vs. 60.0 ± 12.4, P < 0.01). On the day of the mental stress, except for the higher proportion of stress TPD in the MSIMI group, there were no significant differences in EDV, ESV, or EF between the two groups. Moreover, non-invasively measured SBP, DBP, HR, and RPP were similar between the two groups both at rest and during the mental stress test (See Table 2). None of the patients developed chest pain during the test.
The five subscales measured using the SAQ questionnaire were similar between the non-MSIMI and MSIMI groups at baseline. The only exception was physical limitations, which was statistically lower in the MSIMI group than in the non-MSIMI group (52.4 ± 20.2 vs. 58.7 ± 17.6, P = 0.025, See Table 3). During the follow-up at 1 month after coronary revascularization, all subscales were significantly improved in both groups (P < 0.001), except for the subscale of QoL in the MSIMI group. Although the QoL improved significantly in the non-MSIMI group after coronary revascularization, the score was numerically but not statistically deteriorated in the MSIMI group (See Figure 1). Moreover, the QoL score was lower in the MSIMI group than in the non-MSIMI group at follow-up (51.5 ± 22.4 vs. 58.4 ± 22.8, P = 0.031).
Table 4 shows the improvements in the five domains of the SAQ questionnaire. The absolute values of improvements in physical limitations, angina frequency, angina stability, and treatment satisfaction were similar between the two groups. However, the improvement value of QoL showed a significant difference between the two groups (13.1 ± 29.9 vs. −0.2 ± 32.7, P = 0.005, See Figure 2). More patients in the MSIMI group presented a significant improvement in the physical limitation subscale (87.9% vs. 76.3%, P = 0.041), and fewer patients in the MSIMI group showed a significant improvement in the QoL subscale (31.9% vs. 50.5%, P = 0.010). Overall, the QoL showed a consistently deteriorated trend in the MSIMI group but not in the non-MSIMI group.
In this CAD associated with depression/anxiety cohort, the probability of MSIMI after 4 weeks of coronary revascularization was approximately two times in patients with deterioration in QoL than that of improvement in QoL (unadjusted hazard ratio [HR]: 2.019, 95% confidence interval [CI]: 1.122–3.634; adjusted HR: 1.968, 95% CI: 1.083–3.578). Similarly, an improved QoL score of <16 was associated with a twofold increase in the probability of MSIMI when compared with a score of ≥16 (unadjusted HR: 2.184, 95% CI: 1.199–3.979; adjusted HR: 2.105, 95% CI: 1.145–3.873) (See Table 5). Furthermore, a score of <8 in the improved subscale of physical limitations was associated with a 55.6% lower probability of MSIMI when compared with a score of ≥8 (unadjusted HR: 0.444, 95% CI: 0.201–0.979); however, after adjusting for the baseline factors, the association with MSIMI did not exhibit statistical significance. In addition, although the decrease in angina frequency had no association with MSIMI, after adjustment, it was associated with 2.336 times higher probability of MSIMI (adjusted HR: 2.336, 95% CI: 1.029–5.301). For the other two subscales, including angina stability and treatment satisfaction, the association between deterioration or no significant improvement and MSIMI had no statistical significance.