Unignorable Influence of Chest Pain on Mood Symptoms and Prognostic Values in Coronary Artery Disease: A Cross-sectional Study

Abstract Background Prior studies examining depression and anxiety among individuals with coronary artery disease (CAD) have predominantly concentrated on their connection with clinical and laboratory markers, disregarding the profound effect of the cardinal symptom—chest pain. The potential influence of chest pain on the prognostic significance of depression and anxiety, encompassing cardiovascular outcomes, has yet to be fully investigated. Methods Secondary analyses based on a cross-sectional research for investigating prevalence of mood symptoms/disorder in CAD patients. Five-hundred and sixty-one consecutive inpatients were enrolled. The prognostic data was consistently monitored over a median follow-up period of 26 months. The aims of this study were to determine the influence of chest pain on depression and anxiety symptoms and their prognostic effects in CAD. Logistic regression models were used for selecting the most relevant predictors for mood symptoms. Cox regression model were applied for analyzing the prognostic values. Results The prevalence of having depression and anxiety symptoms in CAD reached 37.6% and 27.3%, respectively. Comprehensive analyses revealed that the primary correlated factors for depression were chest pain frequency, age, history of diabetes, and exercise time, and for anxiety were chest pain frequency, chest pain course, and education level. As the common and strongest predictor, chest pain frequency demonstrated a dose-dependent relationship with the risk for mood symptoms. Chest pain frequency and course were not directly associated with prognosis, however impact the prognostic effect of mood symptoms. The association between major adverse cardiovascular events (MACEs) and depression symptoms was primarily observed in patients with a high chest pain frequency, whereas with anxiety was mainly presented in patients with a short chest pain course. For noncardiac rehospitalization, anxiety presented higher predictive value in participants with low chest pain frequencies, while depression was right the opposite. Conclusions These findings underscore the significance of considering chest pain as a crucial factor when investigating the influence of mood symptoms in CAD patients. Particularly, individuals with mood symptoms who experience frequent chest pain episodes despite a short course warrant special attention. Enhancing their emotional well-being and addressing chest pain symptoms might potentially yield valuable clinical benefits.