Higher anxiety score in patients with non-obstructive coronary artery disease

Background: There is insufficient evidence on the relationship between psychological distress and patients with non-obstructive coronary artery disease (NOCAD) who experience angina symptoms despite having non-significant narrowing or normal coronary arteries. Therefore, our aim is to evaluate the psychological distress status in patients with NOCAD. Materials and Methods: In this prospective cross-sectional study, patients with symptomatic angina scheduled for coronary angiography were screened and invited to participate, alongside a control group of non-symptomatic individuals. Symptomatic patients were categorized as having obstructive (OCAD) or NOCAD based on angiogram results. All participants completed the Hospital Anxiety and Depression Scale (HADS) to assess their psychological state and provided blood samples for stress biomarker analysis. Results: A total of 124 subjects participated in this study. The prevalence of anxiety and depression (HADS score ≥8) in patients with OCAD and NOCAD were 26.2% and 25%, respectively. The HADS anxiety (HADS–A) score was higher in both OCAD ( P < 0.001) and NOCAD ( P = 0.001) patients compared to controls. In addition, the HADS depression score was higher in OCAD patients as compared to the control. Notably, the HADS–A score was associated with NOCAD (odds ratio [95% confidence interval], 1.213 [1.029, 1.499]; P = 0.021). Furthermore, cortisol levels were higher in OCAD as compared to controls ( P = 0.028). Conclusion: Higher anxiety scores indicate significant emotional distress in patients with NOCAD. Furthermore, anxiety shows a notable association with NOCAD in patients presenting with angina.