Social inhibition modulates the effect of negative emotions on cardiac prognosis following percutaneous coronary intervention in the drug-eluting stent era

Aims: 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). Methods and 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). Conclusion: 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.

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