The premise gives us two different types of heart disease patients. 1. Those who don't know yet if they need surgery. 2. Those who know what type of treatment they will receive.
Those in group 1 were less likely to experience pain than those in group 2.
We are then given another premise: Uncertainty is more stressful than knowing what one's future holds.
Group 1 has more uncertainty and less pain. What is the link between these things? Stress. This is given to us by A, which is the correct answer. We needed something that explains why the uncertain patients would experience less pain.
I think one reason that this question is confusing, is that we might expect more stress to cause more pain. That is not the case in the context of this passage. Try not to bring your own assumptions, and focus on what is written in the text.