MUNICH — Type D personality is an independent risk factor for death or acute MI following coronary stent placement, regardless of whether a bare metal or drug-eluting stent is deployed, Susanne S. Pedersen, Ph.D., reported at the annual congress of the European Society of Cardiology.
Type D personality is the polar opposite of the aggressive and impatient type A personality. The “D” stands for “distressed.” Type D is a stable, broad personality trait marked by the combination of a high degree of negative affect coupled with inhibited self-expression in social interactions. The type D individual is reserved, insecure—even timid—anxious, and uneasy interacting with others.
Prior studies have shown that type D personality is a cardiac risk factor and that coronary artery disease patients with type D personality have worse outcomes than patients without this personality structure. Dr. Pedersen presented the first study to evaluate the impact of type D personality on clinical outcomes in the contemporary drug-eluting stent era of percutaneous revascularization.
She reported on 875 consecutive participants in the Rapamycin [sirolimus]-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) registry who completed the Type D Personality Scale 6 months after undergoing percutaneous intervention with either a bare metal or sirolimus-eluting stent.
The scale is a brief 14-item standardized and validated instrument well suited for use not only in trials but also as a risk-stratification tool in clinical practice, according to Dr. Pedersen of Tilburg (Netherlands) University.
The primary end point in this RESEARCH substudy was the combined rate of death or nonfatal MI during the 9 months following patient completion of the Type D Personality Scale, that is, during months 6-15 post stenting.
Of the 875 patients, 254 (29%) were classified as type D on the basis of their test scores. They were significantly more likely than were non-type D patients to be current smokers (37% vs. 29%, respectively), but the two groups didn't otherwise differ in terms of the standard cardiovascular risk factors.
The rate of the combined study end point in type D subjects was 5%. In a multivariate logistic regression analysis, type D personality was an independent predictor of death or MI, conferring a 5.3-fold increased risk. The only other independent risk factor for these adverse outcomes was a history of prior coronary artery bypass surgery, associated with a 3.0-fold risk.
There was no association between stent type and risk of the combined end point. This finding is in keeping with other studies showing a dramatic reduction in restenosis with drug-eluting stents, compared with bare metal stents, but no significant differences between the two stent types in mortality or MI, the psychologist noted.