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PERSONALITY AND CARDIAC RISK

Type D personality predicts death or myocardial infarction after bare metal stent or sirolimus-eluting stent implantation

A rapamycin-eluting stent evaluated at rotterdam cardiology hospital (RESEARCH) registry substudy

Susanne S. Pedersen, PhD^*,,*, Pedro A. Lemos, MD^*, Priya R. van Vooren^*, Tommy K.K. Liu^*, Joost Daemen^*, Ruud A.M. Erdman, PhD^*,, Pieter C. Smits, MD, PhD^*, Patrick W.J.C. Serruys, MD, PhD, FESC, FACC^* and Ron T. van Domburg, PhD^*

^* Departments of Cardiology and Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands;
Department of Medical Psychology and Psychotherapy,Erasmus Medical Center, Rotterdam, The Netherlands
Department of Psychology and Health, Tilburg University, Tilburg, The Netherlands

Manuscript received March 10, 2004; revised manuscript received April 23, 2004, accepted May 18, 2004.

^* Reprint requests and correspondence: Dr. Susanne S. Pedersen, Department of Psychology and Health, Tilburg University, Room P503a, Warandelaan 2, 5000 LE Tilburg, The Netherlands (Email: s.s.pedersen{at}uvt.nl).

OBJECTIVES: We investigated the effect of Type D personality on the occurrence of adverse events at nine months in patients with ischemic heart disease (IHD) after percutaneous coronary intervention (PCI) with sirolimus-eluting stents (SESs) or bare stents. Type D patients experience increased negative emotions and tend not to express these emotions in social interactions.

BACKGROUND: The SES is a new advent in interventional cardiology that reduces the restenosis rate and the risk of a major adverse cardiac event, but the SES has not been shown to confer any benefits on death or myocardial infarction (MI).

METHODS: Consecutive patients with IHD (n = 875) enrolled in the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry completed the Type D Personality Scale (DS14) six months after PCI. The end point was a composite of death and MI. Events occurring before administration of the DS14 were excluded from analyses.

RESULTS: At nine months' follow-up, there were 20 events. Type D patients were at a cumulative increased risk of adverse outcome compared with non-Type D patients: 5.6% versus 1.3% (p < 0.002). Type D personality (odds ratio [OR] 5.31; 95% confidence interval [CI] 2.06 to 13.66) remained an independent predictor of adverse outcome adjusting for all other variables, including SES versus bare-stent implantation.

CONCLUSIONS: Type D personality was an independent predictor of adverse events in patients optimally treated with the latest advent in interventional cardiology. The DS14 could be used as a screening instrument in routine clinical practice to optimize risk stratification in IHD patients.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   CABG = coronary artery bypass graft surgery   CI = confidence interval   CK = creatine kinase   IHD = ischemic heart disease   MI = myocardial infarction   NA = negative affectivity   OR = odds ratio   PCI = percutaneous coronary intervention   RESEARCH = Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital registry   SES = sirolimus-eluting stent   SI = social inhibition   TIMI = Thrombolysis In Myocardial Infarction   TNF = tumor necrosis factor

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