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Psychosocial Factors of Women With MI With or Without Obstructive CAD
Quick Takes
- Women with MI-CAD were more likely than women with MINOCA to report high stress in the 4 weeks preceding acute MI and at 2 months after MI.
- There were no differences in depressive symptoms between women with MINOCA and MI-CAD either acutely or in follow-up.
- Perceived stress and depression decreased over 2 months in most women, but a subset had persistent or increased symptoms over time.
Study Questions:
Are women with myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) and those with MI and obstructive coronary artery disease (CAD) (MI-CAD) more likely to have worse stress, depression, and other psychological factors after MI?
Methods:
The study was a secondary analysis of the HARP (Women’s Heart Attack Research Program) study, an international, multicenter, prospective study investigating the mechanisms of MI in women, with a focus on patients with MINOCA. The HARP program also included a randomized controlled trial of a stress management intervention for women with MINOCA or MI-CAD. Women screened for either study completed psychosocial questionnaires at the time of MI and 2 months post-MI. Women, aged ≥21 years, referred for diagnostic coronary angiography to investigate clinical diagnosis of MI were included. Patients who were unable to consent or who had cognitive impairment or psychosis were excluded. Women who had an MI >60 days prior to questionnaire completion were excluded.
Women completed measures of perceived stress (Perceived Stress Scale [PSS-4]) and depressive symptoms (Patient Health Questionnaire [PHQ-2]) at the time of MI (baseline) and 2 months later. A life events scale (LES) and the Global Perceived Stress Scale (GPSS) were also used. Stress and depression, and changes over time, were compared between MI subtypes. Baseline characteristics and LES, GPSS, and PHQ-2 were compared between the two groups.
Results:
Women with MINOCA were younger (age 59.4 vs. 64.2 years, p < 0.001) and were more ethnically diverse than women with MI-CAD. MINOCA patients were less likely to have hypertension (52% vs. 69%, p = 0.002), diabetes mellitus (21% vs. 42%, p < 0.001), and dyslipidemia (41% vs. 57%, p = 0.006), but rates of prior MI and heart failure did not differ. Women with MINOCA were less likely to have high stress (PSS-4 ≥6) at the time of MI (51.0% vs. 63.0%, p = 0.021) and at 2 months post-MI (32.5% vs. 46.3%, p = 0.019) than women with MI-CAD. There was no difference in elevated depressive symptoms (PHQ-2 ≥2) at the time of MI (36% vs. 43%, p = 0.229) or at 2 months post-MI (39% vs. 40%, p = 0.999). In a four-way comparison including spontaneous coronary artery dissection (SCAD) and Takotsubo patients as well as MINOCA and MI-CAD, there was no difference across groups. There were no differences in the rate of 2-month decline in stress and depression scores observed between groups.
Conclusions:
MINOCA patients were less likely to report high stress compared with MI-CAD patients, but the frequency of elevated depressive symptoms did not differ between the two groups. Stress and depressive symptoms decreased in both MI-CAD and MINOCA patients over time.
Perspective:
Although MINOCA is hypothesized to be more prevalent among patients with high stress and depression levels, studies comparing psychosocial factors in MINOCA versus MI with obstructive CAD (MI-CAD) are small and yielded inconsistent findings. The VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study evaluated patients aged <55 years at the time of an MI and found that there was no difference between perceived stress between the two groups. But they included patients who had MINOCA and SCAD in that cohort. Another study by Daniel and colleagues showed that patients with MINOCA had higher stress and anxiety as compared to MI with CAD. But this was confounded by including patients with Takotsubo syndrome in the cohort. The present study included MINOCA, MI-CAD, SCAD, and Takotsubo disease separately in the analysis.
The study found that perceived stress at the time of and 2 months after MI is not more common among women with MINOCA than among those with obstructive CAD. Additional studies are needed to determine whether interventions that reduce perceived stress improve outcomes among women survivors of MI with or without obstructive CAD.
Clinical Topics: Cardiovascular Care Team, Prevention, Atherosclerotic Disease (CAD/PAD), Stress
Keywords: Coronary Artery Disease, Myocardial Infarction, Stress, Psychological
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