AIMS: Negative mood states (e.g., anxiety and depression) have been associated 
with increased cardiovascular morbidity and mortality in coronary artery disease 
(CAD), but little is known about the impact of positive emotions on these health 
outcomes. We examined whether anhedonia (i.e., reduced positive affect) was 
associated with 7-year mortality in patients treated with percutaneous coronary 
intervention (PCI).
METHODS: Consecutive PCI patients (n = 1206; 71.5% men; mean age 62.0 ± 11.1 
years) from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology 
Hospital (RESEARCH) registry completed the Hospital Anxiety and Depression Scale 
(HADS) to assess anhedonia at baseline. Anhedonia was defined as a score ≤ 7 
(i.e., one SD below the mean) on the positive affect scale of the HADS. The 
endpoint was defined as all-cause mortality.
RESULTS: The prevalence of anhedonia was 23.7% (286/1206). After a median follow 
up of 7.0 ± 1.6 years, 186 deaths (15.4%) from any cause were recorded. The 
incidence of mortality in anhedonic patients was 22.7% (65/286) vs. 13.2% 
(121/920) in non-anhedonic patients (HR = 1.66, 95% CI [1.19-2.32], p = 0.003). 
Cumulative hazard functions were significantly different for anhedonic vs. 
non-anhedonic patients (log-rank χ(2) = 16.61, p < 0.001). In multivariable 
analysis, anhedonia remained independently associated with all-cause mortality 
(HR = 1.51, 95% CI [1.03-2.22], p = 0.036), after adjusting for 
socio-demographics, clinical characteristics, and negative and relaxed affect.
CONCLUSION: Anhedonia was independently associated with a 1.5-fold increased 
risk for all-cause mortality in patients who survived the first 6 months 
post-PCI. Enhancing positive emotions, in addition to reducing negative 
emotions, may constitute an important target for future psychological 
intervention trials in CAD patients.