Coronary artery dominance and the risk of adverse clinical events following percutaneous coronary intervention: insights from the prospective, randomised TWENTE trial

Lam, Ming Kai; Tandjung, Kenneth; Sen, Hanim; Basalus, Mounir W.Z.; Houwelingen, K. Gert van; Stoel, Martin G.; Louwerenburg, J. W.; Linssen, Gerard C.M.; Saïd, Salah A.M.; Nienhuis, Mark B.; Man, Frits H.A.F. de; Palen, Job van der; Birgelen, Clemens von

doi:10.4244/eijv11i2a32

Cited by 19 publications

(17 citation statements)

References 26 publications

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“…Our findings confirm previous studies in patients undergoing PCI demonstrating that LD was associated with increased odds of death or re‐infarction during long‐term follow‐up . However, in contrast to several recent studies in patients with ACS, we did not observe an association between LD and 30‐days mortality following PCI .…”

Section: Discussionsupporting

confidence: 83%

“…Indeed, in patients undergoing cardiac catheterization for an acute coronary syndrome (ACS), LD seems to be independently associated with increased mortality and re‐infarction and may predispose individuals to mechanical complications of myocardial infarction (MI) . In contrast, there is conflicting data on the association of LD and outcomes in patients with stable coronary artery disease (CAD): while a computed tomography coronary angiography (CCTA) study found LD to be an independent predictor of non‐fatal MI and all‐cause mortality in a heterogeneous population of patients with chest pain, other studies did not observe differences in clinical endpoints between dominance groups .…”

Section: Introductionmentioning

confidence: 99%

“…tomography coronary angiography (CCTA) study found LD to be an independent predictor of non-fatal MI and all-cause mortality in a heterogeneous population of patients with chest pain, other studies did not observe differences in clinical endpoints between dominance groups [8][9][10].…”

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confidence: 96%

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Coronary dominance and prognosis in patients with chronic total occlusion treated with percutaneous coronary intervention

Gebhard

Gick

Ferenc

et al. 2017

Cathet Cardio Intervent

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Aim The prognostic value of coronary artery dominance pattern in patients with chronic total occlusions (CTO) is unknown. The aim of this study was to assess the influence of coronary vessel dominance on short and long‐term outcomes in patients undergoing percutaneous coronary intervention (PCI) for CTO. Methods and results Our study population consisted of 2002 consecutive patients (17% females, mean age 65.2 ± 10.7 years) who underwent PCI of at least one coronary CTO lesion at our center between 01/2005 and 12/2013. Based on the origin of the posterior descending coronary artery, coronary circulation was categorised into left, right, and balanced coronary dominance. Right coronary dominance (RD) was present in 88% (n = 1759), left coronary dominance (LD) in 7% (n = 136), and balanced coronary dominance (BD) in 5% (n = 107) of the study population. After a median follow‐up duration of 2.6 years [interquartile range 1.1–3.1 years] all‐cause mortality was significantly higher in patients with LD as compared with RD and BD (log rank = 0.001). Accordingly, the presence of a LD system was identified as a significant predictor for all‐cause mortality (adjusted HR 1.7, 95% CI: 1.2‐2.6, P = .007) and major adverse cardiac events (MACE) (adjusted HR 1.4, 95% CI: 1.1‐1.8, P = 0.02). Conclusion Our data suggest that LD is an independent predictor of increased all‐cause death and MACE in patients with CTO. Therefore, assessment of coronary vessel dominance by angiography may contribute to risk stratification in these patients.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

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Coronary dominance and prognosis in patients with chronic total occlusion treated with percutaneous coronary intervention

Gebhard

Gick

Ferenc

et al. 2017

Cathet Cardio Intervent

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“…First, it has been shown that patients with left dominant system are at high risk in terms of cardiovascular events[6]; hence, it is important that significant CAD is promptly addressed in these patients. If the diagnostic accuracy of SPECT MPI is particularly low in this sub group of patients, then it is important that more studies are done to evaluate the negative predictive value (NPV) in this subset to reach a better understanding about role of SPECT MPI in excluding significant CAD in these patients.…”

Section: Discussionmentioning

confidence: 99%

Significance of inferior wall ischemia in non-dominant right coronary artery anatomy

Malik

Abela

Devabhaktuni

et al. 2017

WJC

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AIMTo investigate the relationship of inferior wall ischemia on myocardial perfusion imaging in patients with non-dominant right coronary artery anatomy.METHODSThis was a retrospective observational analysis of consecutive patients who presented to the emergency department with primary complaint of chest pain. Only patients who underwent single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) were included. Patients who showed a reversible defect on SPECT MPI and had coronary angiography during the same hospitalization was analyzed. Patients with prior history of coronary artery disease (CAD) including history of percutaneous coronary intervention and coronary artery bypass graft surgerys were excluded. True positive and false positive results were identified on the basis of hemodynamically significant CAD on coronary angiography, in the same territory as identified on SPECT MPI. Coronary artery dominance was determined on coronary angiography. Patients were divided into group 1 and group 2. Group 1 included patients with non-dominant right coronary artery (RCA) (left dominant and codominant). Group 2 included patients with dominant RCA anatomy. Demographics, baseline characteristics and positive predictive value (PPV) were analyzed for the two groups.RESULTSThe mean age of the study cohort was 57.6 years. Sixty-one point seven percent of the patients were males. The prevalence of self-reported diabetes mellitus, hypertension and dyslipidemia was 36%, 71.9% and 53.9% respectively. A comparison of baseline characteristics between the two groups showed that patients with a non-dominant RCA were more likely to be men. For inferior wall ischemia on SPECT MPI, patients in study group 2 had a significantly higher PPV, 32/42 (76.1%), compared to patients in group 1, in which only 3 out of the 29 patients (10.3%) had true positive results (P value < 0.001 Z test). The difference remained statistically significant even when only patients with left dominant coronary system (without co-dominant) were compared to patients with right dominant system (32/40, 76.1% in right dominant group, 3/19, 15.8% in left dominant group, P value < 0.001 Z test). There was no significant difference in mean hospital stay, re-hospitalization, and in-hospital mortality between the two groups.CONCLUSIONThe positive predictive value of SPECT MPI for inferior wall ischemia is affected by coronary artery dominance. More studies are needed to explain this phenomenon.

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“…17 In the study conducted in Netherlands, the pattern was 9.8% LD and 90.2% non-LD. 18 In the study conducted in Rawalpindi (Pakistan) , the subjects were found to have 84.9% RD, 11.3% LD, and 3.8% CD. 19 In a study conducted in Kathmandu (Nepal), RD was found in 83%, LD in 10%, and CD in 7% .…”

Section: Resultsmentioning

confidence: 98%

Study of coronary artery dominance in Nepalese population by angiographic method

et al. 2017

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Background and Aims: Coronary artery disease is one of the major causes of death in developed countries. The aim of this study was to determine the pattern of coronary artery dominance in our Nepalese population by coronary angiography method and its correlation with the extent of coronary artery disease. Methods: A six-month hospital based prospective observational study of 220 patients (from August 2016 to January 2017) of either gender of 18 years of age or more, eligible for coronary angiography for diagnostic purpose, were performed in this study. The patients with valvular heart disease, congenital heart disease were excluded. The sociodemographic profile of the patients, pattern of coronary artery dominance and its association with coronary artery diseases were all recorded on a proforma. The data were subjected to statistical analysis. Results: A total of 220 patients, 66.82% (n=147) were male and 33.18% (n=73) were female. The mean age was 59.11±11.61 years. The age range was 34-81 years. There was no in-hospital mortality. Right coronary artery was dominant in 85.5%, left dominant in 10 % and co-dominant in 4.5% of the patient population. Abnormal ECG (due to ST-T changes) was 68.18% in left dominant and 42.02% in right dominant. The chance of having coronary artery disease with abnormal ECG (due to ST-T changes) compared to normal ECG is 24 times more in left dominant and 3.875 times more in right dominant. Conclusions: The right coronary dominant pattern is more prevalent in our population. There is no significant association of age and sex with coronary dominance. The Left coronary dominant pattern is more associated with the presence of coronary artery diseases.

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Coronary artery dominance and the risk of adverse clinical events following percutaneous coronary intervention: insights from the prospective, randomised TWENTE trial

Cited by 19 publications

References 26 publications

Coronary dominance and prognosis in patients with chronic total occlusion treated with percutaneous coronary intervention

Coronary dominance and prognosis in patients with chronic total occlusion treated with percutaneous coronary intervention

Significance of inferior wall ischemia in non-dominant right coronary artery anatomy

Study of coronary artery dominance in Nepalese population by angiographic method

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