VITAL EXHAUSTION, EXTENT OF ATHEROSCLEROSIS, AND THE CLINICAL COURSE AFTER SUCCESSFUL PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

It has been observed that vital exhaustion, a state characterized by u nusual tiredness, increased irritability and feelings of demoralizatio n not uncommonly precedes myocardial infarction in apparently healthy individuals. This observation raised the question as to whether vital exhaustion is a marker of subclinical coronary disease. To answer that question the condition was assessed in 105 male patients (mean age 54 .8 year) before and 2 weeks after successful percutaneous transluminal coronary angioplasty (PTCA) by the Maastricht questionnaire. Vital ex haustion was found to be significantly correlated with the number of d iseased vessels before PTCA and to decrease significantly after PTCA. However, the association was rather modest (R(2)=0.08) and most patien ts remained exhausted after PTCA. During a follow-up period of 1.5 yea rs, 32 patients (30%) experienced a new cardiac event (cardiac death, myocardial infarction, coronary artery bypass grafting, repeat PTCA, a new coronary lesion or recurrent angina with documented ischaemia). U nivariate and multivariate analyses showed that the number of diseased vessels, hypercholesterolaemia, and vital exhaustion were independent ly associated with future events. The odds ratios were 3.74 (P=0.02), 3.08 (P=0.08) and 3.07 (P=0.04), respectively. It is concluded that th e tiredness preceding a cardiac event is only modestly associated with the extent of coronary artery disease and that a state of exhaustion after PTCA increases the risk for a new cardiac event.