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European Heart Journal Advance Access published online on October 24, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi616
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received July 15, 2005
Revised September 30, 2005
Accepted October 6, 2005

Clinical research

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

Johan Denollet 1*, Susanne S. Pedersen 2, Andrew T.L. Ong 3, Ruud A.M. Erdman 4, Patrick W. Serruys 3, and Ron T. van Domburg 3

1 Medical Psychology, Department of Psychology and Health, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
2 Medical Psychology, Department of Psychology and Health, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands; Thoraxcentre, Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
3 Thoraxcentre, Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
4 Thoraxcentre, Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Medical Psychology and Psychotherapy, Erasmus Medical Centre, Rotterdam, The Netherlands

* To whom correspondence should be addressed.
Johan Denollet, E-mail: denollet{at}uvt.nl


  Abstract

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.

Keywords: Coronary heart disease; Prognosis; Social inhibition; Negative affectivity; Sirolimus-eluting stent; Type D personality.
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