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Effect of escitalopram on mental stress-induced myocardial ischemia: results of the REMIT trial.

Publication ,  Journal Article
Jiang, W; Velazquez, EJ; Kuchibhatla, M; Samad, Z; Boyle, SH; Kuhn, C; Becker, RC; Ortel, TL; Williams, RB; Rogers, JG; O'Connor, C
Published in: JAMA
May 22, 2013

IMPORTANCE: Mental stress can induce myocardial ischemia and also has been implicated in triggering cardiac events. However, pharmacological interventions aimed at reducing mental stress-induced myocardial ischemia (MSIMI) have not been well studied. OBJECTIVE: To examine the effects of 6 weeks of escitalopram treatment vs placebo on MSIMI and other psychological stress-related biophysiological and emotional parameters. DESIGN, SETTING, AND PARTICIPANTS: The REMIT (Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment) study, a randomized, double-blind, placebo-controlled trial of patients with clinically stable coronary heart disease and laboratory-diagnosed MSIMI. Enrollment occurred from July 24, 2007, through August 24, 2011, at a tertiary medical center. INTERVENTIONS: Eligible participants were randomized 1:1 to receive escitalopram (dose began at 5 mg/d, with titration to 20 mg/d in 3 weeks) or placebo over 6 weeks. MAIN OUTCOMES AND MEASURES: Occurrence of MSIMI, defined as development or worsening of regional wall motion abnormality; left ventricular ejection fraction reduction of 8% or more; and/or horizontal or down-sloping ST-segment depression of 1 mm or more in 2 or more leads, lasting for 3 or more consecutive beats, during 1 or more of 3 mental stressor tasks. RESULTS: Of 127 participants randomized to receive escitalopram (n = 64) or placebo (n = 63), 112 (88.2%) completed end point assessments (n = 56 in each group). At the end of 6 weeks, more patients taking escitalopram (34.2% [95% CI, 25.4%-43.0%]) had absence of MSIMI during the 3 mental stressor tasks compared with patients taking placebo (17.5% [95% CI, 10.4%-24.5%]), based on the unadjusted multiple imputation model for intention-to-treat analysis. A significant difference favoring escitalopram was observed (odds ratio, 2.62 [95% CI, 1.06-6.44]). Rates of exercise-induced ischemia were slightly lower at 6 weeks in the escitalopram group (45.8% [95% CI, 36.6%-55.0%]) than in patients receiving placebo (52.5% [95% CI, 43.3%-61.8%]), but this difference was not statistically significant (adjusted odds ratio; 1.24 [95% CI, 0.60-2.58]; P = .56). CONCLUSIONS AND RELEVANCE: Among patients with stable coronary heart disease and baseline MSIMI, 6 weeks of escitalopram, compared with placebo, resulted in a lower rate of MSIMI. There was no statistically significant difference in exercise-induced ischemia. Replication of these results in multicenter settings and investigations of other medications for reducing MSIMI are needed. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00574847.

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

May 22, 2013

Volume

309

Issue

20

Start / End Page

2139 / 2149

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Stress, Psychological
  • Selective Serotonin Reuptake Inhibitors
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine
  • Female
  • Exercise
 

Citation

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Jiang, W., Velazquez, E. J., Kuchibhatla, M., Samad, Z., Boyle, S. H., Kuhn, C., … O’Connor, C. (2013). Effect of escitalopram on mental stress-induced myocardial ischemia: results of the REMIT trial. JAMA, 309(20), 2139–2149. https://doi.org/10.1001/jama.2013.5566
Jiang, Wei, Eric J. Velazquez, Maragatha Kuchibhatla, Zainab Samad, Stephen H. Boyle, Cynthia Kuhn, Richard C. Becker, et al. “Effect of escitalopram on mental stress-induced myocardial ischemia: results of the REMIT trial.JAMA 309, no. 20 (May 22, 2013): 2139–49. https://doi.org/10.1001/jama.2013.5566.
Jiang W, Velazquez EJ, Kuchibhatla M, Samad Z, Boyle SH, Kuhn C, et al. Effect of escitalopram on mental stress-induced myocardial ischemia: results of the REMIT trial. JAMA. 2013 May 22;309(20):2139–49.
Jiang, Wei, et al. “Effect of escitalopram on mental stress-induced myocardial ischemia: results of the REMIT trial.JAMA, vol. 309, no. 20, May 2013, pp. 2139–49. Pubmed, doi:10.1001/jama.2013.5566.
Jiang W, Velazquez EJ, Kuchibhatla M, Samad Z, Boyle SH, Kuhn C, Becker RC, Ortel TL, Williams RB, Rogers JG, O’Connor C. Effect of escitalopram on mental stress-induced myocardial ischemia: results of the REMIT trial. JAMA. 2013 May 22;309(20):2139–2149.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

May 22, 2013

Volume

309

Issue

20

Start / End Page

2139 / 2149

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Stress, Psychological
  • Selective Serotonin Reuptake Inhibitors
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine
  • Female
  • Exercise