To Örebro University

BACKGROUND: Myocardial infarction with non-obstructive coronary arteries (MINOCA) and takotsubo syndrome (TS) are both characterised by lack of significant coronary artery stenoses and a higher prevalence of mental health disorders preceding the event. Currently, little is known about their pathological aetiologies and subsequent treatment plans, giving cause for concern among those affected. The objective of this review is to provide a comprehensive overview of mental health status and quality of life (QoL) in MINOCA- and TS-patients after the acute event, compared to both cardiac and non-cardiac populations, and over time.

METHODS: A systematic search was conducted via Cochrane Library, CINAHL, PyschINFO, PubMed, ASSIA, Web of Science, Scopus and Embase from inception to May 2024. The review was registered in PROSPERO and methods, and results were reported in accordance with the PRISMA guidelines. Quality assessment and risk of bias were evaluated using the Newcastle-Ottawa Scale for cross-sectional and cohort studies.

RESULTS: Sample sizes ranged from 13 to 5,322 participants. The risk of bias was high in 18/28, medium in 7/28, and low in 3/28 studies. Across the symptoms assessed, MINOCA- and TS-patients reported worse mental health status or QoL than non-cardiac groups in 10/13 studies, and cardiac groups in 10/20 studies. Investigating change over time, 1/5 studies found deteriorating mental health status, 3/5 reported improved mental health status or QoL and 1/5 reported no change in MINOCA- and TS-patients.

CONCLUSIONS: Patients with MINOCA or TS seem to have worse mental health status and QoL after the acute event than non-cardiac individuals, but it is yet difficult to conclude whether mental distress and QoL are equal or worse compared to CHD-patients. There is no convincing evidence that mental health status or QoL of MINOCA- and TS- patients naturally improve over time after the acute event. Among the studies evaluated, risk of bias was high. More high-quality studies are needed, investigating mental health status and QoL among MINOCA- and TS-patients.