American College of Cardiology

American College of Cardiology

March 19, 2020
2 min read

Myocardial ischemia from mental stress after MI confers poor outcomes

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Viola Vaccarino

Young and middle-aged patients with mental stress-induced myocardial ischemia after an MI were over two times more likely to have recurrent MI or CV mortality compared with those without the condition, according to data presented at the American College of Cardiology Scientific Session.

Emotional stress is important in the prognosis of MI patients vulnerable to this phenomenon of myocardial ischemia induced by mental stress, therefore it would be important to test stress reduction interventions that could ameliorate this problem in this population,” Cardiology Today Editorial Board Member Viola Vaccarino, MD, PhD, Wilton Looney Professor of Cardiovascular Research in the department of epidemiology at Emory University Rollins School of Public Health, said during a consumer web briefing.

MI hospitalization within 8 months

Researchers analyzed data from 306 patients (mean age, 50 years; 150 women) aged 61 years or younger who were hospitalized for MI in the past 8 months. Standardized measures were used to assess behavioral, clinical and psychosocial factors. Myocardial perfusion imaging was performed with conventional and mental stress. Conventional stress-induced ischemia and mental stress-induced myocardial ischemia were defined as a new or worsening perfusion defect.

“Mental stress-induced ischemia is provoked by an acute psychological stressor rather than a physical stressor,” Vaccarino said during the briefing. “This phenomenon is relatively common among cardiac patients, up to 50% in some series. It’s generally clinically silent and it’s not related to severity of atherosclerotic plaques. It can also occur in the absence of conventional stress ischemia.”

Follow-up was conducted for 3 years, during which researchers monitored for any adverse events including a composite endpoint of CV death or recurrent MI.

Mental stress-induced myocardial ischemia was observed in 16% of patients, and 35% of patients had conventional ischemia.

During follow-up, two patients died from CV causes and 28 patients had a recurrent MI.

Patients with mental stress-induced myocardial ischemia were more likely to meet the composite endpoint compared with those without the condition (20% vs. 8%; HR = 2.6; 95% CI, 1.2-5.6). Researchers did not observe substantial changes in this relationship after adjusting for clinical and demographic risk factors and depressive symptoms.

No significant relationship was observed between conventional stress ischemia and outcomes (HR = 1.4; 95% CI, 0.6-3).

Further research

“At this moment, we have specifically established that stress is very important in post-MI patients, and therefore it’s important to recognize it,” Vaccarino said during the Q&A portion of the briefing. “Whether we can deliver this kind of testing in the clinical population requires further research. We need to study and develop methods that are feasible to be deployed in the clinical setting. Most likely the protocol we’ve been using in our research is too long and complex to be done in a feasible fashion in the clinic, but we’re working on developing methods to use clinically.” – by Darlene Dobkowski


Almuwaqqat Z, et al. Highlighted Original Research: Acute and Stable Ischemic Heart Disease and the Year in Review. Presented at: American College of Cardiology Scientific Session; March 28-30, 2020 (virtual meeting).

Disclosure: Vaccarino reports no relevant financial disclosures.