716-2 Myocardial Ischemia Induced by Mental Stress Predicts a Poorer Prognosis in Patients with Coronary Artery Disease

Abstract

Although it is clear that mental distress elicits myocardial ischemia, the relationship of mental stress-induced myocardial ischemia (MSI) to prognosis in patients with CAD is unknown. 130 CAD patients with stable angina underwent a series of mental stress and exercise tests using radionuclide ventriculography and standard 12-lead ECG, then were followed for one year, Myocardial ischemia was defined as a new wall-motion abnormality, ejection fraction (EF) decrease >5%. or ST-segment depression ≥0.1 mV from baseline. Cardiac events (CE) were defined as CABG, PTCA, unstable angina admission requiring angiography (UA), nonfatal myocardial infarction (NMI), and cardiac death, of the 130 patients, 50% had both MSI and exercise-induced ischemia (ESI), 18% experienced MSI alone. and 18% had ESI alone. Of the 117 patients achieving one-year follow-up, 20 suffered various CE: 19 had UA, 9 had PTCA, 4 had CABG. 2 had NMI, and 1 died. Logistic regression analyses were performed to examine the possible relationships among age, baseline systolic blood pressure (SBP), baseline EF, MSI, ESI and CE. Results showed that baseline SBP and MSI, but not ESI, were univariable predictors of CE (see Table). Multivariable logistic models were then used, with age, baseline SBP, and baseline EF as covariables, to determine if the addition of either MSI or ESI provided prognostic information in predicting CE. MSI was independently predictive of CE after adjustment for the covariables.Univariablex2p ValueAge0.490.48Baseline SBP5.320.02Baseline EF0.0010.97MSI4.770.03ESI0.480.49 In conclusion, MSI may have greater prognostic potential than ESI for a specific population of CAD patients.