SMOKING STATUS AND TYPE D PERSONALITY AFFECT THE CLINICAL OUTCOME IN PATIENTS WITH RECENT MYOCARDIAL INFARCTION UNDERGONE TO PRIMARY PERCUTANEOUS CORONARY INTERVENTION

Background. Smoking cessation is correlated to several psychological, social, biological, and pharmacological aspects. It’s important to identify differences concerning personality traits in order to increase chances to discontinue cigarette smoking. The combined tendency to experience negative emotions and to inhibit the expression of these emotions is indicated as “Type D personality”, already known as an independent risk marker for worse clinical outcome in cardiac diseases. Despite this effect of Type D personality on cardiovascular diseases, it is still unclear whether this trait of personality may influence smoking cessation after a myocardial infarction.
Methods and Results. 231 smokers with ST-elevation myocardial infarction (STEMI), treated with primary percutaneous coronary intervention (pPCI), were enrolled in this study. Type D Scale-16 (DS16) was administered during hospital stay. Patients have been followed-up for 4.5 years. After controlling for demographic and clinical confounders, non-Type D patients reported statistically significant higher frequencies of smoking cessation (84%) when compared with Type D group (31%). Stop smokers had a better lipid profile, mainly due to HDL-C plasma levels raising (+9.3% vs -1.1%, p<0.001), and better cardiovascular outcome. Moreover, type D patients had a significantly higher incidence of cardiovascular events during the long-term follow-up: type D former smokers showed a similar cumulative rate of new CV events with respect
to current non-Type D smokers during the follow-up, but the occurrence reported in current type D smokers was almost 4-fold (p<0.0001 for Chi square).
Conclusions. Type D smokers quit smoking hardly, even after an acute cardiovascular event (less than one out of three patients), and had an higher recurrence rate also with respect to current non-Type D smokers. Type D personality is confirmed as an independent risk factors for cardiovascular disease, also in addition to smoke habit. In order to be effective, offering and providing a genuine cessation counseling and suggesting a correct treatment are fundamental in reducing smoking addiction, especially in subpopulations with previous cardiovascular events and specific personality traits (i.e. type D personality).