شخصیت نوع-D اثر منفی بر خستگی حیاتی در بیماران PCI تحت درمان با استنت تاکسل اعمال می کند

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.

Vital exhaustion is a mental state characterized by unusual fatigue, demoralization, and increased irritability [1]. Exhaustion is an etiological risk factor for ischemic heart disease and all-cause mortality in healthy individuals [2] and a prognostic risk factor for adverse health outcomes in patients following percutaneous coronary intervention (PCI) and myocardial infarction (MI) [3], [4], [5] and [6]. The risk associated with exhaustion in patients with established cardiovascular disease (CVD) ranges from two- to three-fold [3] and [5], making it a risk factor on par with traditional biomedical risk factors [6] and [7]. Of note, exhaustion is not merely a marker of subclinical CVD but a risk factor in its own right [3].