Anxiety in patients with acute myocardial infarction: prevalence and prognosis
Authors: Izquierdo Coronel B , Lopez Pais J , Nieto Ibanez D , Olsen Rodriguez R , Abad Romero R , Perela Alvarez C , Martin Munoz M , Alvarez Bello M , Galan Gil D , Espinosa Pascual M J , Fraile Sanz A , Mata Caballero R , Ceballo Silva J F , Awamleh Garcia P , Alonso Martin J J 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): SPANISH SOCIETY OF CARDIOLOGY.

Introduction
Although some studies suggest a relationship between mental health and cardiovascular disease, the initial approach of patients with myocardial infarction does not usually include the evaluation of psychological stress as a contributing factor to cardiovascular disease.
This study aims to compare the prevalence of anxiety between patients with obstructive coronary artery disease (MICAD) and those without significant coronary obstruction (MINOCA) and its impact on prognosis.

Methods
During a five-year period (July 2017-July 2022), all consecutive patients with myocardial infarction and coronarography were included. The state-trait anxiety inventory (STAI) was completed by each patient during admission. STAI is a self-report assessment device that includes separate measures of state of anxiety (STAI-S) and trait anxiety (STAI-T). Follow-up analysis included major adverse cardiovascular events (MACE: cardiovascular readmission, myocardial reinfarction, stroke, and death from any cause).

Results
Among 533 patients, 56 had MINOCA, and 477 had MICAD. There were no significant differences in the prevalence of anxiety between both groups: trait anxiety median value (M) MINOCA=18 (11-34) vs MICAD M=19 (12-27), p=0.8; state anxiety MINOCA M=19 (11-29) vs MICAD M=19 (12.2-26), p=0.6.
Because of the fact that women had higher punctuation levels than men, data were analyzed separately without finding statistical differences between sex: STAI-T in MINOCA women M=22 (13–27) vs MICAD M=25 (13–32.5), p=0.9. STAI-S in MINOCA women M=23 (16.2–37) vs MICAD M=21 (13.5-28.5), p = 0.2.
In a similar way, there were no differences between men: STAI-T in MINOCA men M=14 (10-21) vs MICAD M=18 (12-25), p=0.48. STAI-S in MINOCA men M=15 (9-25) vs MICAD M=18 (12-26), p=0.35. (Figure 1).
In the total group of patients at the three-year follow-up, the median score value for women in STAI-T was 24 points (13-34) and in men 17.5 points (11-25), where a higher score was related to more MACE. Both women and men who scored over the median value presented more MACE: number of MACE under the median value =32, MACE over the median value =49, (IC [1.05-2.56], p=0.03). There were no differences in survival (IC [0.6-3,8], p=0.3). Median values for STAI-S were different: women M=22 (14-29.5), men M= 18 (12-26) and a higher score did not correlate with more MACE: (IC [0.55-1.33], p=0.5), nor with mortality: (IC [0.5-2.8], p=0.6).

Conclusion
In this study, the prevalence of anxiety was similar between MINOCA and MICAD patients. A higher score in the anxiety-trait questionnaire was related to a worse prognosis at the three-year follow-up. The anxiety trait component gives information about the patient´s baseline anxiety and it is important in the development of MACE.