Effect of a Nonpharmacological Psychological Stress Management Intervention on Major Cardiovascular Events and Mortality in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Psychological stress is associated with major adverse cardiovascular events (MACE). The objective of this systematic review (SR) is to evaluate the effect of nonpharmacological psychological stress management interventions on MACE and mortality in patients with coronary artery disease. SR and meta-analysis of randomized clinical trials of adult patients with coronary artery disease undergoing nonpharmacological psychological stress management interventions. MEDLINE, Cochrane, LILACS, APA PsycInfo, Clinical Trials databases, and gray literature were used for the search. There were no limits regarding publication status, year, or language. The analyzed outcome was a combination of MACE (cardiovascular mortality, nonfatal infarction, revascularization, nonfatal stroke, and cardiovascular hospitalization). The secondary outcomes were total mortality. Results were expressed as risk ratio (RR) with their 95% confidence interval (95% CI). The random effects model was used for the analyses, the Cochrane Risk of Bias 2 tool to risk of bias and RStudio for the statistical analyses. Prospective International Register of Systematic Reviews and meta-analysis (CRD42021275198). This SR included seven randomized clinical trials (n = 1,908). There was no effect attributable to the intervention on reducing MACE (34.54% vs. 39.05%; RR = 0.84; 95% CI [0.63, 1.12], p = .24; 95% PI [0.35, 2.02]; I-2 = 74.7%, p = .001) or on the analysis of isolated events. The intervention reduced the risk of total mortality by 37% (8.58% vs. 13.62%; RR = 0.63; 95% CI [0.42, 0.95], p = .03; 95% PI [0.18, 2.25]; I-2 = 23.8%, p = .27). This meta-analysis showed no significant decrease in psychological intervention for stress management in MACE, but a significant decrease in mortality.