Vol 31, No 2 (2024)
Original Article
Published online: 2023-04-14

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Prevalence and prognosis of anxiety, insomnia, and type D personality in patients with myocardial infarction: A Spanish cohort

Barbara Izquierdo Coronel1, Javier López Pais2, Daniel Nieto Ibáñez1, Renée Olsen Rodríguez1, David Galán Gil3, Cristina Perela Álvarez1, Rocío Abad Romero1, María Álvarez Bello1, María Martín Muñoz1, María Jesús Espinosa Pascual1, Rebeca Mata Caballero14, Alfonso Fraile Sanz14, Paula Awamleh García1, Francisco Fernández-Avilés56, Joaquín J. Alonso Martín14
Pubmed: 37067334
Cardiol J 2024;31(2):261-270.


Background: It has been suggested that patients with myocardial infarction and non-obstructive coronary arteries (MINOCA) have more psycho-emotional disorders than patients with obstructive coronary artery disease (MICAD). The aim of this study is to compare the prevalence of anxiety, insomnia, and type D personality between MINOCA and MICAD and their impact on prognosis. Methods: Patients with myocardial infarction undergoing coronary angiography were prospectively enrolled. Psychological questionnaires were completed by each patient during admission. Results: Among a total of 533 patients, 56 had MINOCA and 477 had MICAD. There were no differences in the prevalence of anxiety and insomnia between both groups: trait anxiety median value (M) MINOCA = 18 (11–34) vs. MICAD M = 19 (12–27), p = 0.8; state anxiety MINOCA M = 19 (11–29) vs. MICAD M = 19 (12.2–26), p = 0.6; and insomnia MINOCA M = 7 (3–11) vs. MICAD M = 7 (3–12), p = 0.95. More MINOCA patients had type D personality (45.0% vs. 28.5%, p = 0.03). At 3-year follow-up, there were no differences in mortality between MINOCA and MICAD (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.28–2.17) in major adverse cerebral or cardiovascular events (MACCE) (HR 0.71, 95% CI 0.38–1.31). Scores of trait anxiety and negative affectivity were significantly associated with MACCE (HR 1.65, 95% CI [1.05–2.57]; HR 1.75, 95% CI [1.11–2.77], respectively). High insomnia levels were associated with greater mortality (HR 2.72, 95% CI [1.12–6.61]). Conclusions: Anxiety and insomnia levels were similar between patients with MINOCA and those with MICAD, whilst the prevalence of type D personality was higher in the MINOCA than in the MICAD group. Higher scores in trait anxiety, insomnia, and negative affectivity were related to a worse prognosis at 3-year follow-up.

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