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European Heart Journal Advance Access originally published online on October 24, 2005
European Heart Journal 2006 27(2):171-177; doi:10.1093/eurheartj/ehi616
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

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

Johan Denollet1,*, Susanne S. Pedersen1,2, Andrew T.L. Ong2, Ruud A.M. Erdman2,3, Patrick W. Serruys2 and Ron T. van Domburg2

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

Received 15 July 2005; revised 30 September 2005; accepted 6 October 2005; online publish-ahead-of-print 24 October 2005.

* Corresponding author. Tel: +31 13 466 2390; fax: +31 13 466 2370. E-mail address: denollet{at}uvt.nl

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.

Key Words: Coronary heart disease • Prognosis • Social inhibition • Negative affectivity • Sirolimus-eluting stent • Type D personality


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