Anxiety and prognosis of patients with myocardial infarction: A meta-analysis

Abstract

Although anxiety is highly prevalent after myocardial infarction (MI), but the association between anxiety and MI is not well established. This study aimed to provide an updated and comprehensive evaluation of the association between anxiety and short-term and long-term prognoses in patients with MI. Anxiety is associated with poor short-term and long-term prognoses in patients with MI. We performed a systematic search in the PubMed and Cochrane databases (January 2000-October 2020). The study endpoints were complications, all-cause mortality, cardiac mortality, and/or major adverse cardiac events (MACEs). Pooled data were synthesized using Stata SE12.0 and expressed as risk ratios (RRs) and 95% confidence intervals (CIs). We included 9373 patients with MI from 16 published studies. Pooled analyses indicated a correlation between high anxiety and poor clinical outcomes (RR: 1.19, 95% CI: 1.13-1.26, p < .001), poor short-term complications (RR: 1.23, 95% CI: 1.09-1.38, p = .001), and poor long-term prognosis (RR: 1.27, 95% CI: 1.13-1.44, p < .001). Anxiety was also specifically associated with long-term mortality (RR: 1.16, 95% CI: 1.01-1.33, p = .033) and long-term MACEs (RR: 1.54, 95% CI: 1.26-1.90, p < .001). This study provided strong evidence that increased anxiety was associated with poor prognosis in patients with MI. Further analysis revealed that MI patients with anxiety had a 23% increased risk of short-term complications and a 27% increased risk of adverse long-term prognosis compared to those without anxiety.

Keywords: anxiety; meta-analysis; myocardial infarction; prognosis.

FIGURE 1

Flow chart of searching results. CI, confidence interval; MI, myocardial infarction; RR, risk ratio

FIGURE 2

Forest plots of the relationship between anxiety and clinical outcomes in patients with MI (A), subgroup analysis of excluding studies in which anxiety were evaluated before MI (B), subgroup analysis of multivariable RRs (C), subgroup analysis after adjusting of depression (D). MI, myocardial infarction; RR, risk ratio

FIGURE 3

Forest plots of the relationship between anxiety and long‐term prognosis in patients with MI (A), subgroup analysis of multivariable RRs (B), subgroup analysis after adjusting of depression (C). MI, myocardial infarction; RR, risk ratio

FIGURE 4

Funnel plots of the meta‐analysis of anxiety and prognosis in patients with MI. Clinical outcomes (A), long‐term prognosis (B). MI, myocardial infarction