Social inhibition modulates the effect of negative emotions on cardiac prognosis following percutaneous coronary intervention in the drug-eluting stent era

• Published in: European heart journal Vol. 27; no. 2; pp. 171 - 177
• Main Authors: Denollet, Johan, Pedersen, Susanne S., Ong, Andrew T.L., Erdman, Ruud A.M., Serruys, Patrick W., van Domburg, Ron T.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.01.2006; Oxford Publishing Limited (England)
• Subjects: Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Coronary Disease - psychology; Coronary Disease - therapy; Coronary heart disease; Emotions; Female; Heart; Humans; Immunosuppressive Agents - administration & dosage; Inhibition (Psychology); Interpersonal Relations; Male; Medical sciences; Middle Aged; Negative affectivity; Prognosis; Risk Factors; Sirolimus - administration & dosage; Sirolimus-eluting stent; Social inhibition; Stents; Type D personality; Heart; Prognosis; sirolimus-eluting stent; Angioplasty; Coronary artery; Instrumentation therapy; Cardiovascular disease; Emotion emotionality; Personality; Type D personality; Coronary heart disease; Phlebology; Coated material; Social inhibition; Negative affectivity; Type; Circulatory system; Inhibition; Cardiology; Drug eluting stent
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehi616

Aims Negative emotions have an adverse effect on cardiac prognosis. We investigated whether social inhibition (inhibited self-expression in social interaction) modulates the effect of negative emotions on clinical outcome following percutaneous coronary intervention (PCI). Methods and results Eight hundred and seventy-five consecutive patients from the RESEARCH registry (Erasmus Medical Centre, Rotterdam) completed depression, anxiety, negativity (negative emotions in general), and social inhibition scales 6 months following PCI. The endpoint was major adverse cardiac event (MACE—death, myocardial infarction, coronary artery bypass graft (CABG), or PCI) at 9 months following assessment. There were 100 MACE; patients who were high in both negativity and inhibition were at increased risk of MACE (38/254=15%) when compared with high negativity/low inhibition patients (13/136=10%; P=0.018). Depression (P=0.23) or anxiety (P=0.63) did not explain away this moderating effect of inhibition. High negativity/high inhibition (HR=1.92, 95%CI 1.22–3.01, P=0.005) and previous CABG (HR=1.90, 95%CI 1.04–3.47, P=0.038) were independent predictors of MACE. Patients with high negativity but low inhibition were not at increased risk (P=0.76). High negativity/high inhibition also independently predicted death/MI (n=20) as a more specific endpoint (HR=5.85, P=0.001). Conclusion The interaction effect of social inhibition and negative emotions, rather than negative emotions per se, predicted poor clinical outcome following PCI. Social inhibition should not be overlooked as a modulating factor.