Assessing myocardial microcirculation in post-PCI patients with chest pain and anxiety: a dynamic CT myocardial perfusion study with mental stress testing.

BACKGROUND

Some patients after percutaneous coronary intervention (PCI) still have chest pain, accompanied by anxiety. Mental stress test (MST) can trigger myocardial ischemia in patients with anxiety. This study assessed the myocardial microcirculation of post-PCI patients with anxiety using mental stress dynamic CT myocardial perfusion imaging (CT-MPI).

METHODS

Post-PCI patients with chest pain underwent CT-MPI with MST using a series of the standardized color word/arithmetic stressors, and divided into anxiety group and non-anxiety group according to the generalized anxiety disorder scale. Myocardial blood flow (MBF) and myocardial blood flow reserve (MFR) were analyzed, using a 17-segment model.

RESULTS

Fifty-one patients with 867 segments were included for final analysis, including 26 patients with anxiety and 25 patients without anxiety. The anxiety group had a lower MBF in stent areas compared to non-stent areas after MST (P < 0.05), but this phenomenon was not observed in the non-anxiety group. Anxiety severity was negatively correlated with global MFR (r=-0.542, P = 0.004) and positively correlated with decreased global MBF value (r = 0.577, P = 0.012). Multivariate logistic regression analysis identified anxiety as an independent risk factor for MBF reduction after coronary stent implantation (OR = 5.54, 95%CI: 1.47-20.88, P = 0.011).

CONCLUSIONS

Anxiety is associated with myocardial microcirculation dysfunction (MMD) in post-PCI patient, particularly in areas supplied by stented arteries. Anxiety is a risk factor for MMD under mental stress in post-PCI patients.