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European Heart Journal 1995 16(1):1880-1885;
Copyright © 1995 by the European Society of Cardiology.
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© 1995 The European Society of Cardiology

Vital exhaustion, extent of atherosclerosis, and the clinical course after successful percutaneous transluminal coronary angioplasty

A. APPELS*,, W. KOP{dagger}, F. BÄR{ddagger}, H. DE SWART{ddagger} and C. MENDES DE LEON§

*Department of Medical Psychology, Cardiovascular Research Institute Maastricht The Netherlands
{dagger}Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences Bethesda, U.S.A.
{ddagger}Department of Cardiology, Cardiovascular Research Institute Maastricht The Netherland
§Department of Epidemiology and Public Health, School of Medicine, Yale University New Haven, U.S.A.

revised 12 December 1994; accepted 4 April 1995.

Correspondence: A. Appels, Department of Medical Psychology, Cardiovascular Research Institute, Postbus 616, 6200 MD. Maastricht, The Netherlands

Abstract

It has been observed that vital exhaustion, a state characterized by unusual tiredness, increased irritability and feelings of demoralization not uncommonly precedes myocardial infarction in apparently healthy individuals. This observation raised the question as to whether vital exhaustion is a marker of subclinical coronary disease. To answer that question the condition was assessed in 105 male patients (mean age 54·8 year) before and 2 weeks after successful percutaneous transluminal coronary angioplasty (PTCA) by the Maastricht questionnaire. Vital exhaustion was found to be significantly correlated with the number of diseased vessels before PTCA and to decrease significantly after PTCA. However, the association was rather modest (R2=0·08) and most patients remained exhausted after PTCA. During a follow-up period of 1·5 years, 32 patients (30%) experienced a new cardiac event (cardiac death, myocardial infarction, coronary artery bypass grafting, repeat PTCA, a new coronary lesion or recurrent angina with documented ischaemia). Univariate and multivariate analyses showed that the number of diseased vessels, hypercholesterolaemia, and vital exhaustion were independently associated with future events. The odds ratios were 3·74 (P=0·02), 3·08 (P=0·08) and 3·07 (P=0·04), respectively. It is concluded that the tiredness preceding a cardiac event is only modestly associated with the extent of coronary artery disease and that a state of exhaustion after PTCA increases the risk for a new cardiac event.

Key Words: Exhaustion • PTCA • myocardial infarction


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