Impact of type D personality on clinical outcomes in Spanish patients with myocardial infarction
Authors: Izquierdo Coronel B , Santiago-Ruiz J L , Lopez Pais J , Nieto Ibanez D , Perela Alvarez C , Alvarez Bello M , Martin Munoz M , Rodriguez Fuentes P , Gil Mancebo N , Olsen Rodriguez R , Espinosa Pascual M J , Fraile Sanz A , Mata Caballero R , Awamleh Garcia P , Alonso Martin J J 
Published: June 2024

Abstract

Introduction
There is controversy whether type D personality may be related to clinical outcomes in patients (pts) with myocardial infarction (MI). This study aims to investigate the association between type D personality and clinical outcomes in pts with MI in a Spanish cohort.

Methods
All consecutive pts with MI who underwent coronary angiography were prospectively enrolled from July 2017 to December 2021. Mean follow up was 31.4±19 months. Type D personality was assessed using the DS14 questionnaire (Denollet, 2005), which pts completed during their admission. Type D is a combination of two personality traits: social inhibition (SI) and negative affectivity (NA). The total score in each subgroup ranges from 0 to 28 points. Pts were classified as "Type D" when they scored higher than the predetermined cut-off of 10 points on both the NA and SI scores. The primary endpoint was the time to the first major adverse cardiovascular event (MACE), defined as the occurrence of nonfatal myocardial infarction, stroke, cardiovascular readmission or death. To evaluate the time to the first event, a survival analysis was performed using the Kaplan-Meier procedure. Statistical significance was determined using the log-rank test.

Results
The study included 538 patients, among which 199 (37%) completed the DS14 questionnaire and of them, 96 (48.3%) had type D personality.
Pts with type D personality were mostly women (32 vs 18%, p=0.02) and there were fewer smokers (65 vs 80%, p=0.02). There were no significant differences in other baseline characteristics: age (65.7 vs 66.4 years old), hypertension (55 vs 57%), diabetes (33 vs 26%), dyslipemia (54 vs 53%), previous MI (18 vs 17%) and previous stroke (1 vs 0%). No statistically significant differences were found in MACE between both groups (p=0.88, Figure 1). Similarly, no significant differences were detected after adjusting for sex (p=0.92).
We also analysed pts with significant NA, defined as a score of 10 or more points in the NA trait. In this study, 182 pts had significant NA. Compared to those without significant NA, there were more women and fewer smokers in the NA group (31.8 vs 19.7%, p=0.02 and 67 vs 80%, p=0.02 respectively). Regarding the remaining baseline characteristics, no significant differences were observed: age (66.5 vs 66.3 years old), hypertension (57.7 vs 55.3%), diabetes (32.4 vs 25%), dyslipemia (56.9 vs 55.3%), previous MI (18.2 vs 15.2 %) and previous stroke (0.6 vs 0%). Statistically significant differences were found in MACE-free survival, with a higher proportion of events in pts with NA (p=0.04). (Figure 2). Significant differences persisted after adjusting for sex (p=0.03) but disappeared when adjusting for smoking status (p=0.06).

Conclusion
in this study, pts with type D personality and MI did not experience more MACE than pts without type D personality. However, pts with MI who had significant NA, had more MACE compared to those without NA, even after adjusting for sex.