Potential predictors for mental stress-induced myocardial ischemia in patients with coronary artery disease

Mental stress-induced myocardial ischemia (MSIMI) is closely associated with adverse cardiac events in coronary artery disease (CAD) patients and we aimed to determine whether biomarkers and blood pressure could be potential predictors of MSIMI. This study enrolled 82 patients with documented CAD between Jun. 01, 2017 and Nov. 09, 2017. Patient blood samples were obtained at resting period and at the end of mental arithmetic. Then, patients were assigned to MSIMI positive group and MSIMI negative group. The main statistical methods included linear regression, receiver operating characteristic (ROC) curves, logistic regression. CAD patients with MSIMI had significantly greater resting NT-proBNP (141.02 [interquartile range (IQR): 45.85 to 202.76] vs. 57.95 [IQR: 27.06 to 117.64] pg/ml; Z=-2.23, P=0.03) and SBP (145.56 ± 16.87 vs. 134.92 ± 18.16 mmHg, Z = -2.13, P = 0.04) when compared with those without MSIMI. After 5-minute mental stress task, those who developed MSIMI present higher elevation of post stressor hs-cTnI (0.020 [IQR: 0.009 to 0.100] vs. 0.009 [IQR: 0.009 to 0.010]ng/ml; Z = -2.45, P = 0.01), post stressor NT-proBNP (138.96 [IQR: 39.93 to 201.56] vs. 61.55 [IQR: 25.66 to 86.50] pg/ml; Z = -2.15, P = 0.03) compared with those without MSIMI. Using the ROC curves, and after the adjustment for basic characteristics, the multiple logistic regression analysis showed that patients presenting a post stressor hs-cTnI≥0.015 ng/ml had 7-fold (odds ration (OR): 7.09; 95%CI: 1.65-30.48; P = 0.009) increase in the risk of developing MSIMI, a rest NT-proBNP≥80.51 pg/ml had nearly 8-fold increase (OR: 7.85; 95%CI: 1.51-40.82; P = 0.014), a post stressor NT-proBNP≥98.80 pg/ml had 35-fold increase (OR: 34.96; 95%CI: 3.72-328.50; P = 0.002), a rest SBP≥129.50 mmHg had 11-fold increase (OR: 11.42; 95%CI: 1.21-108.17; P = 0.034). The present study shows that CAD patients have higher hs-cTnI level, and/or greater NT-proBNP and/or SBP are at higher risk of suffering from MSIMI when compared with those without MSIMI, indicating that hs-cTnI, NT-proBNP, SBP might be potential predictors of MSIMI.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4