Hostility Predicts Restenosis After
Percutaneous Transluminal Coronary Angioplasty
Mark Goodman, Ph.D., John Quigley, M.A., George
Moran, M.D., Henry Meilman, M.D., and Martin Sherman, Ph.D.
• Objective: To investigate the “toxic”
total (potential for) hostility component of the type A
behavior pattern (assessed by means of the structured interview)
as it relates to prediction of restenosis after percutaneous
transluminal coronary angioplasty (PTCA).
• Design: Patients with single vessel or multivessel
coronary artery disease in whom PTCA had been scheduled
or done were administered the structured interview by one
trained interviewer prospectively or retrospectively (blinded
to angiographic endpoints).
• Material and Methods: A total of 41 patients underwent
53 initial balloon dilations on native arteries by 1 of
5 participating cardiologists. Inclusion criteria for this
study were a successful initial PTCA and post PTCA recatheterization
if a patient complained of ischemic symptoms possibly related
to restenosis.
• Results: Of the 41 patients, 15 (36.6%) had restenoses
at a total of 18 previous angioplasty sites. Patients with
a high total (potential for) hostility ratings were almost
2.5 times more
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likely to have restenosis than those with low total (potential
for) hostility scores (95% confidence interval = 1.03 to
5.32). Logistic regression revealed that total (potential
for) hostility scores predicted post-PTCA restenosis overall
as well as when adjusted for gender and race. Total (potential
for) hostility scores were also positively associated with
the number of arteries restenosed (P = 0.01).
• Conclusion: This is the first report of type
A total (potential for) hostility behavior conferring an
increased risk for restenosis after PTCA. It’s modification
may be effective in reducing recurrent cardiac events. A
coronary-prone behavior modification program for patients
with persistent, same-site restenosis after PTCA has been
initiated.
(Mayo Clin Proc 1996; 71:729-734)
CAD = coronary artery disease; MRFIT
= Multiple Risk Factor Intervention Trial;
PARRFs = postangioplasty restenosis risk factors; PTCA
= Percutaneous transluminal coronary angioplasty; SI
= strutured interview |
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