Coronary artery disease with negative coronary angiogram mimicking primary psychiatric disorders-sociodemographic patterns and etiologies - A comparative cross-sectional study

ABSTRACT Background: Psychiatric disorders are a major health concern worldwide, with significant biopsychosocial consequences. In India, the prevalence of psychiatric illnesses is estimated at 13.9%, with depression and anxiety disorders being among the most prevalent. A notable clinical overlap exists between psychiatric conditions and cardiovascular symptoms, particularly in patients presenting with medically unexplained chest pain, which may mimic coronary artery disease (CAD). This study aims to explore the sociodemographic characteristics, medical comorbidities, and psychosocial stressors in patients with psychogenic chest pain syndrome (PCS) at a tertiary cardiology department and to assess the importance of incorporating psychiatric assessments into routine cardiac care. Methodology: This cross-sectional study was conducted at a tertiary care hospital in South India. A total of 420 participants were recruited, consisting of two groups: 210 patients diagnosed with acute coronary syndrome (ACS) based on positive cardiological tests (control group) and 210 patients presenting with symptoms mimicking ACS but diagnosed with psychiatric disorders (study group). Psychiatric evaluations were conducted using the Mini International Neuropsychiatric Interview and the Patient Health Questionnaire-9, along with other diagnostic tools. Cardiac evaluations included electrocardiogram, troponin-I testing, echocardiography, and coronary angiography. Results: The mean age of the PCS group was significantly lower (42.2 ± 9.6 years) than that of the CAD group (51.4 ± 6.8 years). Gender distribution differed significantly, with the PCS group having an equal male-to-female ratio, while the CAD group had a male predominance. Diabetes and hypertension (HTN) were more prevalent in the CAD group, while hypothyroidism was more common in the PCS group. Depression (38.8%) was the most prevalent psychiatric disorder in the PCS group, followed by various anxiety disorders. Logistic regression analysis revealed that diabetes significantly increased the odds of CAD, whereas hypothyroidism was inversely associated with CAD. Conclusion: This study underscores the significant overlap between psychiatric disorders and ACS, highlighting the need for multidisciplinary evaluations in patients presenting with chest pain. Depression and anxiety disorders were common in the PCS group, while traditional cardiovascular risk factors such as diabetes and HTN predominated in the CAD group. The integration of psychiatric assessments into routine cardiology care is crucial to ensure accurate diagnosis, prevent unnecessary investigations, and improve patient outcomes.