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Cognitive Adaptation as a Predictor of New Coronary Events After Percutaneous Transluminal Coronary Angioplasty

From Carnegie Mellon University (V.S.H.) and University of Pittsburgh (H.L.F.), Pittsburgh, PA.

Address reprint requests to: Vicki S. Helgeson, PhD, Psychology Department, Carnegie Mellon University, Pittsburgh, PA 15213. Email: vh2e+{at}andrew.cmu.edu

OBJECTIVE: We tested whether the psychological components of cognitive adaptation theory would predict new coronary events after a first percutaneous transluminal coronary angioplasty (PTCA).

METHODS: A consecutive sample of patients treated successfully with PTCA were enrolled in the study. Of 343 patients approached, 303 (88%) agreed to participate and were interviewed shortly before hospital discharge. We measured the components of cognitive adaptation theory (optimism, self-esteem, and mastery) during the interview. Five patients were excluded from the analysis because of early, in-hospital reocclusion. New cardiac events (coronary artery bypass grafting, PTCA, myocardial infarction, or disease progression) were examined within 6 months of the first PTCA. We obtained 6-month follow-up data on 98% of patients.

RESULTS: The cognitive adaptation index predicted new cardiac events, even when demographic variables and medical variables thought to predict restenosis were statistically controlled (p = .02).

CONCLUSIONS: These results suggest that persons who respond to their illness by perceiving control over their futures, by having positive expectations about their futures, and by holding a positive view of themselves seem to be at less risk for a new cardiac event after a first PTCA.

Key Words: angioplasty • new cardiac events • restenosis • psychological variables

Abbreviations: CABG = coronary artery bypass grafting; CI = confidenceinterval; LAD = left anterior descending (artery); MI =myocardial infarction; PTCA = percutaneous transluminal coronaryangioplasty.

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