Predisposition to psychological distress in patients with coronary artery disease and three-year prognosis after coronary artery stenting

Aim. To study the prognostic value of type D personality on the three-year prognosis in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI).

Material and methods. The study included 112 patients hospitalized for preparation for elective PCI. All patients underwent a standard preoperative examination. Additionally, the psychological status of patients was assessed (determination of type D personality, assessment of the level of anxiety and depression). Remote results were assessed after 3-year follow-up. The incidence of a combined endpoint (death, nonfatal myocardial infarction and stroke, myocardial revascularization) was assessed in the group without (n=65) and with type D personality (n=38).

Results. Type D personality was detected in 37% of patients. Subjective improvement 3 years after PCI was noted in 86,2% of patients with non-type D and 68,4% with type D personality (p=0,032). Repeat PCI was performed more often in patients with type D (10,5%) than without type D personality (1,5%; p=0,041). The incidence of a combined endpoint was higher in type D than in non-type D patients (21,1% and 7,7%, p=0,04).

Conclusion. The study results highlight the need for individualized behavioral interventions in patients with coronary artery disease with manifestations of psychological distress.

1. Agorastos A, Chrousos GP. The neuroendocrinology of stress: the stress-related continuum of chronic disease development. Mol Psychiatry. 2022;27(1):502-13. doi:10.1038/s41380-021-01224-9.

2. Cao H, Zhao H, Shen L. Depression increased risk of coronary heart disease: A metaanalysis of prospective cohort studies. Front Cardiovasc Med. 2022;9:913888. doi:10.3389/fcvm.2022.913888.

3. Pogosova N, Saner H, Pedersen SS, et al. Psychosocial aspects in cardiac rehabilitation: from theory to practice. A position paper from the cardiac rehabilitation section of the European association of cardiovascular prevention and rehabilitation of the European society of cardiology. Kardiologiia. 2015;55(10):96-108. (In Russ.) doi:10.18565/cardio.2015.10.96-108.

4. Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-337. doi:10.1093/eurheartj/ehab484.

5. Wirtz PH, von Känel R. Psychological Stress, Inflammation, and Coronary Heart Disease. Curr Cardiol Rep. 2017;19(11):111. doi:10.1007/s11886-017-0919-x.

6. O'Riordan A, Gallagher S, Howard S. Type D personality and cardiovascular reactivity to acute psychological stress: A systematic review and meta-analysis. Health Psychol. 2023;42:628-41. doi:10.1037/hea0001328.

7. Kivimäki M, Steptoe A. Effects of stress on the development and progression of cardiovascular disease. Nat Rev Cardiol. 2018;15(4):215-29. doi:10.1038/nrcardio.2017.189.

8. Denollet J. DS14: Standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosomatic Medicine. 2005;67(1):89-97. doi:10.1097/01.psy.0000149256.81953.49.

9. Sumin AN, Shcheglova AV. Is the conceяpt of type D personality a component of personalized medicine or a prognostic factor in the treatment of cardiovascular diseases? Russian Journal of Cardiology. 2020;25(9):3996. (In Russ.) doi:10.15829/1560-4071-2020-3996.

10. Lodder P, Wicherts JM, Antens M, et al. Type D Personality as a Risk Factor for Adverse Outcome in Patients With Cardiovascular Disease: An Individual Patient-Data Metaanalysis. Psychosom Med. 2023;85(2):188-202. doi:10.1097/PSY.0000000000001164.

11. Lv H, Tao H, Wang Y, et al. Impact of type D personality on major adverse cardiac events in patients undergoing percutaneous coronary intervention: The mediating role of cognitive appraisal and coping style. J Psychosom Res. 2020;136:110192. doi:10.1016/j.jpsychores.2020.110192.

12. Sumin AN, Shcheglova AV. Pathogenetic Mechanisms Underlying Major Adverse Cardiac Events in Personality Type D Patients after Percutaneous Coronary Intervention: The Roles of Cognitive Appraisal and Coping Strategies. Diagnostics (Basel). 2023;13(21):3374. doi:10.3390/diagnostics13213374.

13. Sumin AN, Raikh OI, Gaifulin RA, et al. Predisposition to psychological distress in patients after coronary bypass surgery: relation to one year prognosis. Kardiologiia. 2015;55(10):76-82. (In Russ.). doi:10.18565/cardio.2015.10.76-82.

14. Pushkarev GS, Bessonov IS, Kuznetsov VA, et al. Prognostic significance of psychosocial risk factors in patients with ischemic heart disease after percutaneous coronary interventions. Kardiologiia. 2017;57(6):11-5. (In Russ.) doi:10.18565/cardio.2017.6.11-15.

15. Raykh OI, Sumin AN, Korok EV. The Influence of Personality Type D on Cardiovascular Prognosis in Patients After Coronary Artery Bypass Grafting: Data from a 5-Year-Follow-up Study. Int J Behav Med. 2022;29(1):46-56. doi:10.1007/s12529-021-09992-y.

16. Mommersteeg PMC, Lodder P, Aarnoudse W, et al. Psychosocial distress and health status as risk factors for ten-year major adverse cardiac events and mortality in patients with non-obstructive coronary artery disease. Int J Cardiol. 2024;406:132062. doi:10.1016/j.ijcard.2024.132062.