To the Editor Dr Jiang and colleagues1 reported that 6 weeks of escitalopram treatment in patients with stable coronary heart disease (CHD) and MSIMI at baseline resulted in lower rates of MSIMI compared with placebo. Several clarifications would help to determine the generalizability and external validity of the study findings.
Of the 2694 patients screened for eligibility, only 400 provided consent, 335 underwent MSIMI testing, 132 were identified as having MSIMI, and 127 eventually qualified for the study. The low consent rate (15%) raises concerns as to whether any differences in demographic, psychiatric, or CHD-related characteristics between the included and excluded patients might have biased the results.
Shiyovich A. Therapy for Mental Stress–Induced Myocardial Ischemia. JAMA. 2013;310(13):1401. doi:10.1001/jama.2013.277966