Association between quality of life and mental stress-induced myocardial ischemia in high-risk patients after coronary revascularization

Objective: We sought to determine the association between mental stress-induced myocardial ischemia (MSIMI) and quality of life (QoL) in patients with coronary artery disease (CAD) after coronary revascularization. Methods: This cohort study involved patients with high-risk MSIMI who were selected from those who received coronary revascularization between Dec 2018 and Dec 2019. Patients with screened depression/anxiety were enrolled in this study. Mental stress was induced by the Stroop Color and Word Test 4 weeks after coronary revascularization. All participants underwent single photon emission computed tomography (SPECT) scans at rest and at mental stress. MSIMI was defined as the presence of four abnormal SPECT phenomena. QoL was assessed using the Seattle Angina Questionnaire (SAQ) before and 4 weeks after coronary revascularization. Results: Of the 1,845 consecutive patients who received coronary revascularization, 590 (31.9%) had depression/anxiety and 205 agreed to accept the mental stress test. During the average follow-up of 42.8 days, 105 (51.2%) patients developed MSIMI. All SAQ subscales were significantly improved, except for QoL, in the MSIMI group. The QoL score was lower (−0.2 ± 32.7 vs. 13.1 ± 29.9, P = 0.005) and the proportion of deterioration in QoL was higher (50.5% vs. 31.9%, P = 0.010) in the MSIMI group than in the non-MSIMI group. Those with a deterioration in QoL were approximately two times as likely to develop MSIMI as those with the improvement in QoL (unadjusted HR: 2.019, 95% CI: 1.122–3.634, P = 0.026; adjusted HR: 1.968, 95% CI: 1.083–3.578, P = 0.017). Conclusion: Among the patients with CAD who received coronary revascularization and had depression/anxiety, deterioration in QoL increased the likelihood of MSIMI. Hence, our results indicate that deterioration in QoL is a predictor of MSIMI. Trail Registration ChiCTR2200055792, retrospectively registered, 2022.1.20, www.medresman.org.cn;