Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysis

Jie Li; Feng Ji; Junxian Song; Xiangyang Gao; Deguo Jiang; Guangdong Chen; Suling Chen; Xiaodong Lin; Chuanjun Zhuo

doi:10.1136/bmjopen-2019-034135

Anxiety and clinical outcomes of patients with acute coronary syndrome: a meta-analysis

BMJ Open. 2020 Jul 9;10(7):e034135. doi: 10.1136/bmjopen-2019-034135.

Authors

Jie Li^#¹, Feng Ji^#², Junxian Song^#³, Xiangyang Gao⁴, Deguo Jiang¹, Guangdong Chen¹, Suling Chen¹, Xiaodong Lin⁵, Chuanjun Zhuo^{6

2

7}

Affiliations

¹ Psychiatric Neuroimaging-Genetic and Comorbidity Laboratory (PNGC_Lab), Tianjin Mental Health Centre, Tianjin Anding Hospital, Tianjin, China.
² Department of Psychiatric-Neuro-Imaging-Genetics Laboratory, School of Mental of Jining Medical University, Jining, China.
³ Department of Cardiology, Center for Cardiovascular Translational Research, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China.
⁴ Health Management Institute, Medical Data Statistical Analysis Center, Medical Big Data Analysis Center, Chinese PLA General Hospital, Beijing, China.
⁵ Department of Psychiatric-Neuro-Imaging-Genetics Laboratory, Wenzhou Seventh People's Hospital, Wenzhou, China.
⁶ Psychiatric Neuroimaging-Genetic and Comorbidity Laboratory (PNGC_Lab), Tianjin Mental Health Centre, Tianjin Anding Hospital, Tianjin, China chuanjunzhuotjmh@163.com.
⁷ Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China.

^# Contributed equally.

Abstract

Objectives: Anxiety has been suggested to be associated with poor outcomes in patients with acute coronary syndrome (ACS). However, results of previous follow-up studies were inconsistent. The aim of this meta-analysis was to evaluate the association between anxiety and clinical outcomes in patients with ACS, and to investigate the potential role of depression underlying the above association.

Design: A meta-analysis of prospective follow-up studies.

Setting: Hospitals.

Participants: Patients with ACS.

Interventions: We included related prospective follow-up studies up through 20 July 2019 that were identified by searching PubMed and Embase databases. A random-effect model was used for the meta-analysis. Anxiety was evaluated by validated instruments at baseline.

Primary and secondary outcome measures: We determined the association between anxiety and risks of mortality and adverse cardiovascular events (MACEs) in patients with ACS.

Results: Our analysis included 17 studies involving 39 038 patients wqith ACS. Anxiety was independently associated with increased mortality risk (adjusted risk ratio (RR) 1.21, 95% CI 1.07 to 1.37, p=0.002) and MACEs (adjusted RR 1.47, 95% CI 1.24 to 1.74, p<0.001) in patients with ACS. Subgroup analyses showed that depression may at least partly confound the association between anxiety and poor outcomes in patients with ACS. Adjustment of depression significantly attenuated the association between anxiety and MACEs (adjusted RR 1.25, 95% CI 1.04 to 1.52, p=0.02). Moreover, anxiety was not significantly associated with mortality risk after adjusting for depression (adjusted RR 0.88, 95% CI 0.66 to 1.17, p=0.37).

Conclusions: Anxiety is associated with increased risk of mortality and MACEs in patients with ACS. However, at least part of the association may be confounded by concurrent depressive symptoms in these patients.

Keywords: Myocardial infarction; acute coronary syndrome; anxiety; major adverse cardiovascular events; mortality.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Acute Coronary Syndrome* / complications
Anxiety / epidemiology
Anxiety Disorders
Humans
Odds Ratio
Prospective Studies
Risk Factors