Goodman M, Quigley J, Moran G, Meilman H, Sherman M
Department of Psychiatry and Behavioral Medicine, Union Memorial Hospital, Baltimore, Maryland, USA.
Mayo Clin Proc. 1996 Aug;71(8):729-34. doi: 10.1016/S0025-6196(11)64836-2.
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).
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).
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.
Of the 41 patients, 15 (36.6%) had restenoses at a total of 18 previous angioplasty sites. Patients with high total (potential for) hostility ratings were almost 2.5 times more 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).
This is the first report of type A total (potential for) hostility behavior conferring an increased risk for restenosis after PTCA. Its 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.
研究A型行为模式中“毒性”总（潜在）敌意成分（通过结构化访谈评估）与经皮腔内冠状动脉成形术（PTCA）后再狭窄预测之间的关系。
对计划或已接受PTCA的单支或多支冠状动脉疾病患者，由一名经过培训的访谈者前瞻性或回顾性地进行结构化访谈（对血管造影终点不知情）。
共有41例患者由5名参与研究的心脏病专家中的1名对其天然动脉进行了53次初始球囊扩张。本研究的纳入标准为初始PTCA成功，且如果患者主诉可能与再狭窄相关的缺血症状，则需进行PTCA术后再次导管插入术。
41例患者中，15例（36.6%）在之前总共18个血管成形术部位出现了再狭窄。总（潜在）敌意评分高的患者发生再狭窄的可能性几乎是总（潜在）敌意评分低的患者的2.5倍（95%置信区间 = 1.03至5.32）。逻辑回归显示，总（潜在）敌意评分总体上以及在对性别和种族进行调整后，均能预测PTCA术后再狭窄。总（潜在）敌意评分也与再狭窄的动脉数量呈正相关（P = 0.01）。
这是关于A型总（潜在）敌意行为使PTCA后再狭窄风险增加的首次报道。对其进行调整可能有效减少复发性心脏事件。已启动针对PTCA后持续出现同部位再狭窄患者的易患冠状动脉行为调整项目。
