title: Social inhibition modulates the effect of negative emotions on cardiac prognosis following percutaneous coronary intervention in the drug-eluting stent era.
abstract: OBJECTIVE
  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).
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Medical Psychology, Department of Psychology and Health, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands. denollet@uvt.nl
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
authors.forename: Andrew T L
authors.initials: AT
authors.lastname: Ong
authors.forename: Ruud A M
authors.initials: RA
authors.lastname: Erdman
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000523:psychology* / Q000628:therapy; D004644:Emotions; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007266:Inhibition, Psychological; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus