Effect of a 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

Introduction: 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 (CAD). Methods: SR and meta-analysis of randomized clinical trials (RCTs) of adult patients with CAD undergoing nonpharmacological psychological stress management interventions. MEDLINE, Cochrane, LILACS, 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 (CI95%). The random effects model was used for the analyses, the RoB2 tool to risk of bias and RStudio for the statistical analyses. Prospective International Register of Systematic Reviews (CRD42021275198).