Little is known about the impact of psychological risk factors on cardiac prognosis in the drug-eluting stent era. We examined whether the distressed personality (Type D) moderates the effect of percutaneous coronary intervention with sirolimus-eluting stent implantation on adverse clinical events at 2-year follow-up. Type D is an emerging risk factor in patients with cardiovascular disease.
Design
Prospective follow-up study.
Methods
Three hundred and fifty-eight patients with ischemic heart disease, who consecutively underwent percutaneous coronary intervention with sirolimus-eluting stent as part of the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital registry, completed the Type D Scale (DS14) post-percutaneous coronary intervention (PCI). The end-point was a composite of death and non-fatal myocardial infarction 2 years after PCI.
Results
At follow-up, there were 22 events (12 deaths and 11 myocardial infarctions). Type D patients had a greater than two-fold risk of an event at follow-up compared with non-Type D patients (10.4 vs. 4.4%, P = 0.031). In multivariable analysis, Type D remained an independent predictor of adverse outcome (hazard ratio: 2.61; 95% confidence interval: 1.12–6.09; P = 0.027) adjusting for sex, age, and history of coronary artery disease, multivessel disease, diabetes, hypercholesterolemia, hypertension, renal impairment and smoking. Previous cardiac history was also an independent predictor of death or myocardial infarction (hazard ratio: 2.83; 95% confidence interval: 1.00–7.96; P = 0.049).
StoneGWEllisSGCoxDAHermillerJO'ShaughnessyCMannJT.; TAXUS-IV Investigators. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease.New Engl J Med2004; 350: 221–231.
2.
MoriceMCSerruysPWSousaJEFajadetJBan HayashiEPerinM.; RAVEL Study Group. Randomized Study with the Sirolimus-Coated Bx Velocity Baloon-Expandable Stent in the Treatment of Patients with de Novo Native Coronary Artery Lesions. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization.N Engl J Med2002; 346: 1773–1780.
3.
ColomboADrzewieckiJBanningAGrubeEHaputmannKSilberS.; TAXUS II Study Group. Randomized study to assess the effectiveness of slow- and moderate-release polymer-based paclitaxel-eluting stents for coronary artery lesions.Circulation2003; 108: 788–794.
4.
HolmesDRFirthBGWoodDL.Paradigm shifts in cardiovascular medicine.J Am Coll Cardiol2004; 43: 507–512.
5.
BabapulleMNJosephLBelislePBrophyJMEisenbergMJ.A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stents.Lancet2004; 364: 583–591.
6.
LemosPASerruysPWVan DomburgRTSaiaFArampatzisCAHoyeA. Unrestricted utilization of sirolimus-eluting stents compared to conventional bare stent implantation in the ‘real world’. The Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry.Circulation2004; 109: 190–195.
7.
Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice. European guidelines on cardiovascular disease prevention in clinical practice.Eur J Cardiovasc Prev Rehabil2003; 10:S1–S78.
8.
AlbusCJordanJHerrmann-LingenC.Screening for psychosocial risk factors in patients with coronary heart disease - recommendations for clinical practice.Eur J Cardiovasc Prev Rehabil2004; 11: 75–79.
9.
BlumenthalJALettHSBabyakMAWhiteWSmithPKMarkDB. the NORG Investigators. Depression as a risk factor for mortality after coronary artery bypass surgery.Lancet2003; 362: 604–609.
10.
KopWJAppelsAPMendes de LeonCFDe SwartHBBarFW.Vital exhaust on pred cts new card ac events after successful coronary angioplasty.Psychosom Med1994; 56: 281–287.
11.
DenolletJSysSUStroobantNRomboutsHGillebertTCBrutsaertDL.Personality as independent predictor of long-term mortality in patients with coronary heart disease.Lancet1996; 347: 417–421.
12.
DenolletJBrutsaertDL.Personality, disease severity, and the risk of long-term cardiac events in patients with decreased ejection fraction after myocardial infarction.Circulation1998; 97: 167–173.
13.
DenolletJVaesJBrutsaertDL.Inadequate response to treatment in coronary heart disease: adverse effects of Type D personality and younger age on 5-year prognosis and quality of life.Circulation2000; 102: 630–635.
14.
PedersenSSDenolletJ.Type D personality, cardiac events, and impaired quality of life: a review.Eur J Cardiovasc Prev Rehabil2003; 10: 241–248.
15.
SchifferAAPedersenSSWiddershovenJWHendriksEHWinterJBDenolletJ.Type D personality is independently associated with impaired health status and increased depressive symptoms in chronic heart failure.Eur J Cardiovasc Prev Rehabil2005; 12: 341–346.
16.
PedersenSSVan DomburgRTTheunsDAMJJordaensLErdmanRAM.Type D personality is associated with increased anxiety and depressive symptoms in patients with an implantable cardioverter defibrillator and their partners.Psychosom Med2004; 66: 714–719.
17.
DenolletJPedersenSSOngATLErdmanRAMSerruysPWVan DomburgRT.Social inhibition modulates the effect of negative emotions on cardiac prognosis following percutaneous coronary intervention in the drug-eluting stent era.Eur Heart J2006; 27: 171–177.
18.
PedersenSSLemosPAVan VoorenPRLiuTDaemenJErdmanRAM. 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 sub-study.J Am Coll Cardiol2004; 44: 997–1001.
19.
LemosPLeeCDegertekinMSaiaFTanabeKArampatzisCA. Early outcome after sirolimus eluting stent implantation in patients with acute coronary syndromes: insights from the rapamycin-eluting stent evaluated at Rotterdam cardiology hospital (RESEARCH) registry.J Am Coll Cardiol2003; 41: 2093–2099.
20.
DenolletJ.DS14: standard assessment of negative affectivity, social inhibition, and Type D personality.Psychosom Med2005; 67: 89–97.
21.
SmithSCJrDoveJTJacobsAKKennedyJWKereiakesDKernMJ., American College of Cardiology, American Heart Association Task Force on Practice Guidelines. Committee to Revise the 1993 Guidelines for percutaneous transluminal coronary angioplasty. ACC∖AHA guidelines of percutaneous coronary interventions (revision of the 1993 PTCA guidelines) -executive summary. A report of the American College of Cardiology∖American Heart Association Task Force on Practice Guidelines (committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty).J Am Coll Cardiol2001; 37: 2215–2239.
22.
PedersenSSMiddelB.Increased vital exhaustion among Type D patients with ischaemic heart disease.J Psychosom Res2001; 51: 443–449.
23.
LibbyPRidkerPMMaseriA.Inflammation and atherosclerosis.Circulation2002; 105: 1135–1143.
24.
ChewDPBhattDLRobbinsMAPennMSSchneiderJPLauerMS. Incremental prognostic value of elevated baseline C-reactive protein among established markers of risk in percutaneous coronary intervention.Circulation2001; 104: 992–997.
25.
GurmHSBhattDLLincoffAMTchengJEKereiakesDJKleimanNS. Impact of preprocedural white blood cell count on long term mortality after percutaneous coronary intervention: insights from the EPIC, EPILOG, and EPISTENT trials.Heart2003; 89: 1200–1204.
26.
ToutouzasKColomboAStefanadisC.Inflammation and restenosis after percutaneous coronary intervention. EurHeart J2004; 25: 1679–1687.
27.
DenolletJConraadsVMBrutsaertDLDe ClerckLSStevensWJVrintsCJ.Cytokines and immune activation in systolic heart failure: the role of Type D personality.Brain Behav Immun2003; 17: 304–309.
28.
DeswalAPetersenNJFeldmanAMYoungJBWhiteBGMannDL.Cytokines and cytokine receptors in advanced heart failure: an analysis of the cytokine database from the Vesnarinone Trial (VEST).Circulation2001; 103: 2055–2059.
29.
OldridgeNSanerHMcGeeHM; for the HeartQoL Study Investigators. The Euro Cardio-QoL Project. An international study to develop a core heart disease health-related quality of life questionnaire, the Heart QoL.Eur J Cardiovasc Prev Rehabil2005; 11: 87–94.
30.
LemosPASerruysPWVan DomburgRT.Sirolimus-eluting stents in the ‘real world’: The RESEARCH registry rationale and study design. In: SerruysPWLemosPA, editors. Sirolimus-eluting stents: From RESEARCH to clinical practice.London: Taylor & Francis; 2005. p. 17.
