The Combined Impact of Type D Personality and Depressive Comorbidity on Post-PCI Major Adverse Cardiac Events: The Mediating Role of Heart Rate Variability

OBJECTIVE: This study aimed to explore the impact of coexisting Type D personality and depression on the incidence of major adverse cardiac events (MACEs) following percutaneous coronary intervention (PCI), and to examine the mediating role of heart rate variability (HRV). METHODS: This prospective cohort study included 990 patients with coronary artery disease who underwent PCI between May 2022 and May 2023. Type D personality, depressive symptoms, and HRV were assessed at baseline. Patients were followed for 2 years to monitor the occurrence of MACE. RESULTS: During the follow-up period, 289 patients experienced MACE. HRV indices were lower in the comorbid group compared with the group without psychological conditions, particularly SDNN (82.50 vs. 94.33) and SDANN (71.32 vs. 80.95). In the "NA×Depression" interaction pathway, the indirect effects of SDNN and SDANN on MACE were statistically significant across low, moderate, and high depression levels, with the a × b effects being 0.676 and 0.688 at low depression, 0.604 and 0.618 at moderate depression, and 0.460 and 0.479 at high depression, respectively. Notably, the indirect effect estimates were slightly larger at low to moderate depression levels, and all values showed significant positive mediation effects. In the "SI×Depression" interaction pathway, the ab indirect effects of SDNN and SDANN were also statistically significant at low, moderate, and high depression levels, with the values being 0.377 and 0.411 at low depression, 0.309 and 0.342 at moderate depression, and 0.174 and 0.204 at high depression. CONCLUSIONS: Type D personality combined with depression elevates post-PCI MACE risk, with NA playing a core role. SDNN and SDANN (key HRV indices) mediate this association, supporting routine psychological and HRV screening plus targeted interventions to improve outcomes.