TweeSteden Mild Stenosis Study (TWIST)
Psychosocial factors have been found to be associated with an increased risk for coronary artery disease incidence, progression and worse clinical outcomes.
Patients with non-significant coronary artery disease (confirmed vascular irregularities, but <60% coronary occlusion) often present with complaints such as chest pain, which warrant screening by coronary angiography (CAG) or computed tomography (CT scan). The prognosis of this group of patients with mild stenosis remains to be investigated in more detail, and we propose that psychosocial factors play a role in the clinical prognosis and patient reported outcomes in this group.
A special focus lies within examining personality characteristics, of which Type D personality is a primary predictor variable for prognosis. Type D personality is characterised by high negative affect and high social inhibition. In addition to psychosocial factors (personality, mood state, social support, SES), biomarkers(inflammation, clotting, DNA) as well as standard clinical risk factors (metabolic syndrome, activity level, smoking, medication use, disease severity) will be investigated.
The goal of the proposed study is to investigate a preexisting psycho-biochemical risk profile for major adverse cardiovascular events (MACE) and patient perceived symptoms in a group with angiographically or CT-scan confirmed, non-significant coronary artery disease.
Coronary Artery Disease
Non-significant Coronary Artery Disease
|Study Design:||Observational Model: Cohort
Time Perspective: Prospective
|Official Title:||A Psycho-biochemical Perspective on Non-significant Coronary Artery Disease: a Prospective Cohort Study of Classic and Novel Risk Markers.|
- Major Adverse Cardiac Events (MACE) [ Time Frame: Average 42 months (Range 12-72; at least 12 months after inclusion final participant) ] [ Designated as safety issue: No ]MACE includes the occurence of a recurrent coronary angiography, emergency hospitalization (for cardiac reasons), myocardial infarction, percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG), mortality (cardiac/noncardiac)
- Patient Perceived Health Status [ Time Frame: 12 and 24 months ] [ Designated as safety issue: No ]patient perceived health status includes self-reported chest pain, disease specific health status, generic health status, fatigue and mood (depression/anxiety). Double time point was included for this outcome measure to examine changes over time, compared to baseline.
- Psychosocial factors [ Time Frame: baseline, 12 and 24 months ] [ Designated as safety issue: No ]
The secondary aim is to investigate the correlation and the stability over time between psychosocial factors, biochemical variables, traditional cardiac risk factors and measures of outcome.
Psychosocial factors include questionnaires as personality scales (Type D personality, Cook-Medley Hostility scale 27 item version), depression (HADS-D at each time point, BDI, CESD-10 and PHQ9 at consecutive time points), anxiety (HADS-A at each time point), fatigue (FAS), global mood scale (Positive and negative affect), generic health status (Short Form 12), specific health status (Seattle Angina Questionnaire). Indicators of education level, marital status, lifestyle factors, and activity level.
- Biochemical correlates [ Time Frame: baseline, 12 and 24 months ] [ Designated as safety issue: No ]
Examine biochemical correlates in relation to psychosocial and traditional cardiac risk factors.
Standard assessment is done for high sensitive C-reactive protein (hsCRP), fibrinogen, leukocyte count and differentiation, and registration of lipid profile, glucose, creatinin at baseline. Baseline and 12 month serum samples are collected and stored at -80, as well as DNA samples for future funding opportunities.
Biospecimen Retention: Samples With DNA
Serum, DNA, leukocyte differentiation, high-sensitive C-reactive protein, fibrinogen
|Study Start Date:||January 2009|
|Estimated Study Completion Date:||May 2025|
|Estimated Primary Completion Date:||May 2015 (Final data collection date for primary outcome measure)|
CAG and CT group
CAG group = patients included based on coronary angiography screening; CT group = patients included based on computed tomography screening
|TweeSteden Hospital Tilburg|
|Tilburg, Dr. Deelenlaan 5, Netherlands, 5042 AD|
|Principal Investigator:||Paula M.C. Mommersteeg, PhD||Tilburg University|
|Principal Investigator:||Jos W. Widdershoven, MD PhD||TweeSteden Hospital, Tilburg, the Netherlands|
|Study Chair:||Wilbert Aarnoudse, MD PhD||TweeSteden Hospital, Tilburg, the Netherlands|
|Study Chair:||Johan Denollet, PhD||Tilburg University|