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  • Title: Type-D personality exerts a stable, adverse effect on vital exhaustion in PCI patients treated with paclitaxel-eluting stents.
    Author: Pedersen SS, Daemen J, van de Sande M, Sonnenschein K, Serruys PW, Erdman RA, van Domburg RT.
    Journal: J Psychosom Res; 2007 Apr; 62(4):447-53. PubMed ID: 17383496.
    Abstract:
    OBJECTIVE: Vital exhaustion is associated with the pathogenesis of cardiovascular disease (CVD), but its prevalence after percutaneous coronary intervention (PCI) with drug-eluting stent implantation, as well as the impact of personality on exhaustion, is not known. In PCI patients, we examined (a) the prevalence of exhaustion, (b) the impact of type-D personality on exhaustion over time, and (c) the clinical significance of type-D personality compared with gender and age as predictors of exhaustion. METHODS: Consecutive patients (n=419) with stable or unstable angina treated with PCI with drug-eluting stent implantation completed the Type-D Scale (DS14) at baseline and the Maastricht Questionnaire (which assesses exhaustion) at baseline and at 1 year. RESULTS: Of all patients, 53% were exhausted at baseline and at 1 year, with 41% experiencing chronic symptoms. Type-D patients [F(1, 417)=98.688; P<.001] had significantly higher exhaustion levels than non type-D patients both at the time of the index PCI and at 1 year. There was a general improvement in symptoms of exhaustion over time [F(1, 417)=5.005; P=.03], but type-D exerted a stable effect on exhaustion (P=.06). In multivariable analysis, type-D (OR=3.53; 95% CI=1.88-6.64) remained an independent predictor of exhaustion at 1 year, adjusting for demographic and clinical risk factors and exhaustion at baseline. The impact of type-D on exhaustion was large compared with a small effect for gender and age, as measured by Cohen's effect size index. CONCLUSIONS: Symptoms of exhaustion were still highly prevalent in PCI patients 1 year post-PCI despite treatment with the latest technique in interventional cardiology. Type-D exerted a large and stable effect on exhaustion compared with that of gender and age. CVD research and clinical practice may benefit by adopting a personality approach in order to identify high-risk patients.
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