Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Pessimism is associated with less improvement in quality of life after PCI in men but not in women – novel insights from the PLA-pCi-EBO-trial
M. Wester1, F. Koll1, M. Lüdde2, C. Langer3, M. Resch4, A. Luchner5, N. Frey6, K. Müller7, F. Zeman7, M. Koller7, L. S. Maier1, S. T. Sossalla1
1Klinik und Poliklinik für Innere Med. II, Kardiologie, Universitätsklinikum Regensburg, Regensburg; 2Kardiologische Gemeinschaftspraxis, Bremerhaven; 3am Klinikum Links der Weser, Kardiologisch-Angiologische Praxis, Bremen; 4Klinik für Innere Medizin, Caritas Krankenhaus St. Josef, Regensburg; 5Klinik für Kardiologie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg; 6Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie, Universitätsklinikum Heidelberg, Heidelberg; 7Zentrum für Klinische Studien, Universitätsklinikum Regensburg, Regensburg;

Background: Improved quality of life (QoL) is an important goal in the treatment for chronic coronary syndrome (CCS). There are important sex-dependent differences regarding symptoms in CCS, some that might be explained physiological. However, psychological factors are crucial contributors to the perception of symptoms, pain, or disease and especially for the symptomatic success of any therapy such as percutaneous coronary intervention (PCI). This analysis evaluates the sex-dependent effect of pessimism on QoL in a real-world all-comer collective of patients with symptomatic CCS.

Methods: This is an additional analysis of the prospective, randomized PLA-pCi-EBO-trial including five academic and large communal hospitals in Germany in which 145 patients (47 female, 98 male) with symptomatic CCS underwent PCI. QoL was assessed using the Seattle Angina Questionnaire (SAQ) at baseline and six months after PCI. The SAQ QoL subscale ranges from 0 (worst QoL) to 100 (best QoL). Pessimism was assessed using the revised life orientation test (LOT-R). The scale ranges from 0 (least pessimistic) to 12 (most pessimistic).

Result: At baseline, pessimism is correlated with reduced QoL (p=0.026, r2=0.027) in the overall study cohort (Fig. A). The median LOT-R value was 5 for the whole collective and also for women and men, respectively. However, the distribution was significantly shifted towards more pessimism for men compared to women (p=0.033, U-test, Fig. B). (C) Women and men where then dichotomized into less (≤7) and more pessimistic (>7) according to the median of a large data sample from the general population. Overall, patients had improved QoL 6 months after PCI. Interestingly, more pessimistic men showed less improvement in QoL than less pessimistic men (+24 points vs +42 points, p=0.002), whereas there was no difference for women regarding pessimism (+37 points vs +29 points, p=0.452, Fig. C). In addition to being statistically significant, the difference of 16 points in the SAQ QoL subscale in less and more pessimistic men can be translated to be highly clinically relevant.

Conclusion: These data show that in patients with symptomatic CCS, pessimism per se is associated with reduced QoL and that men are more pessimistic than women are.  Pessimism is associated with less improvement in QoL after PCI in men but not in women. These insights highlight important psychological sex-related differences regarding CCS and might inform treatment and follow-up decisions in daily clinical practice.


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