Escitalopram for the treatment of mental-stress induced myocardial ischaemia (MSIMI)

Over the last three decades a large body of research has investigated the link between emotional distress and myocardial ischaemia; mental stress-induced myocardial ischaemia (MSIMI) is associated with an increased risk of cardiovascular events and death. Recent studies on selective serotonin reuptake inhibitors (SSRIs) has show that they may reduce the mental stress-induced haemodynamic response, metabolic risk factors, and platelet activity. The REMIT (Responses of Mental Stress Induced Myocardial Ischaemia to Escitalopram Treatment) trial aimed to investigate whether SSRI treatment could improve MSIMI.

The study was a randomised, double-blind, placebo-controlled trial that took place between 2007 and 2001 at a tertiary medical centre. Patients with clinically stable coronary heart disease and laboratory diagnosed MSIMI were randomised to receive escitalopram or placebo over 6 weeks. The main outcome measure was the occurrence of MSIMI, defined as the development of regional wall motion abnormality, a reduction in left ventricular ejection fraction of 8% or more, and/or significant ST depression during mental stressor tasks.

56 patients in the escitalopram and placebo groups completed end point assessments. At the end of 6 weeks, more patients taking escitalopram had absence of MSIMI during mental stressor tasks (34.3% vs. 17.5%, odds ratio 2.62). Although rates of exercise-induced ischaemia were also slightly lower at 6 weeks in the escitalopram group, this difference was not statistically significant (P=.56).


In patients with stable coronary artery disease and mental stress-induced myocardial ischaemia, 6 weeks of escitalopram treatment resulted in lower rates of stress-induced ischaemia when compared with placebo, however no significant difference in exercise-induced ischaemia was seen.

  • Jiang W, Velazquez EJ, Kuchibhatla M et al. Effect of Escitalopram on Mental Stress-Induced Myocardial Ischemia. JAMA 2013;309:2139-2149.

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