Effect of coronary dominance on 2‐year outcomes after percutaneous coronary intervention in patients with acute coronary syndrome

He, Chen; Ma, Yan; Wang, Chuangshi; Song, Ying; Tang, Xiaofang; Zhao, Xueyan; Gao, Runlin; Yang, Yuejin; Xu, Bo; Yuan, Jinqing

doi:10.1002/ccd.26978

Cited by 6 publications

(7 citation statements)

References 18 publications

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“…13 Multiple other studies have reported significant role of left dominance in determining the short and long term fate of patients with STE-ACS. In a study by He C et al 10 , left dominance was reported to be an independent predictor of long-term mortality with 2-year mortality rate of 2.58% against 1.23% mortality in right or codominance (p=0.024). Parikh NI et al 14 in a large registry based study confers the modestly increase in in-hospital mortality after PCI of ACS patients with left dominant system.…”

Section: Discussionmentioning

confidence: 95%

“…Although, the left dominant circulation system is considered a normal entity but its prognostic role has been hypothesized mainly due to unbalanced supply of blood to the cardiac muscle. 10,11 Therefore, we conducted this study to evaluate the role of left dominant circulation system in determining the fate of STE-ACS patients with culprit proximal LAD. It has been observed that, in this particular sub-groups of STE-ACS patients, the clinical manifestation, risk factor distribution, most of the angiographic findings, and hospital course were not different between the left and right dominant groups.…”

Section: Discussionmentioning

confidence: 99%

“…The left dominant circulation system has been reported to be associated a higher risk of post-PCI non-fatal myocardial infarction, immediate mortality, and re-infarciton. [8][9][10] The association of left dominant circulation with the adverse outcomes is hypothesized to be driven by the unbalanced supply of blood to the cardiac muscle, increased risk of failed intervention due to difficult course of the left circumflex artery, and absence of sufficient collateralized blood circulation. 7 In routine clinical practice, the stenosis of left anterior descending artery (LAD) is given attention due to its distinctive prognostic role.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Coronary Artery Dominance In-terms of Presentation and In-hospital Outcomes of patients undergoing Primary PCI for Culprit Proximal Left Anterior Descending Artery

Rai¹,

Kumar²,

Raza³

et al. 2023

Pak Heart J

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Objectives: Objective of this study was to assess the difference in terms of presentation and in-hospital course between patients with right vs. left dominant arterial circulation undergoing “primary percutaneous coronary intervention (PCI)” for culprit proximal left anterior descending artery (LAD). Methodology: We included consecutive adult (≥18 years) patients diagnosed with STE-ACS undergoing primary PCI for culprit proximal LAD. Patients were categorized into right vs. left dominant circulation on left heart catheterization. Demographic, clinical characteristics, presentation, and hospital course were compared between the matched (propensity matched) and unmatched cohort of patients with right vs. left dominance. Results: We included 775 patients, out of which 81.3% (630) were males and mean age was 54.59 ± 11.3 years. On coronary angiogram left dominance was observed in 14.3% (111). Single vessel disease was higher with left compared to right dominant system, 53.2% vs. 43.5%, respectively. The rate of slow flow/no-reflow (15.4% vs. 7.2%; p=0.0.230), heart failure (9.3% vs. 6.3%; p=0.299), and in-hospital mortality (5.1% vs. 3.6%, p=0.493) were not different between right vs. left dominance, respectively. In the matched cohorts, the frequency of slow flow/no-reflow (15.3% vs. 7.2%; p=0.056), heart failure (6.3% vs. 6.3%; p>0.999), and mortality (5.4% vs. 3.6%, p=0.493) were not different between right vs. left dominance, respectively. Conclusion: No significant increase in complications and outcomes is witnessed among patients with left dominant arterial circulation undergoing primary PCI for culprit proximal LAD. However, careful handling of left main during intervention is warranted due lack of support from right system.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Coronary Artery Dominance In-terms of Presentation and In-hospital Outcomes of patients undergoing Primary PCI for Culprit Proximal Left Anterior Descending Artery

Rai¹,

Kumar²,

Raza³

et al. 2023

Pak Heart J

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“…Patients were divided into two groups (LD and RD+CD) based on coronary angiographic images using standard angiographic projections in accordance with the American College of Cardiology/American Heart Association College. RD and CD patients were in the same group because they had been previously reported with similar anatomical and clinical features [4,5] . Moreover, it was not possible to precisely distinguish between CD and RD patients due to diffuse coronary lesions.…”

Section: Study Population and Data Sourcementioning

confidence: 99%

“…However, the differences between coronary dominance types may lead to different clinical outcomes in patients with coronary artery stenosis according to various studies [3] . Left coronary dominance has been shown to be a poor prognostic factor in patients with acute coronary syndrome (ACS) and percutaneous interventions [4,5] . In contrast, the knowledge about the clinical effects of the type of coronary dominance is scarce in patients undergoing surgical revascularization.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Coronary Dominance in Patients Undergoing Elective Coronary Artery Bypass Surgery

Selçuk

Çevirme

Bugra

2020

Braz J Cardiovasc Surg

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Objective: To evaluate the clinical impact of coronary dominance type in terms of early and long-term outcomes in patients undergoing elective coronary artery bypass grafting (CABG).Methods: A total of 844 consecutive patients who underwent elective CABG were divided into two groups based on preoperative angiographic views as left dominant (LD) and right dominant or codominant (RD+CD). The measured outcomes were postoperative complications, 30-day mortality, long-term mortality, and major adverse cardiac and cerebrovascular events (MACCE).Results: RD+CD was present in 87.9% (n=742) and LD in 12.1% (n=102) of patients. Postoperative complications, 30-day mortality, and 30-day readmissions were similar in both groups. The median duration of follow-up was 3.4 years. LD was not an independent predictor of mortality (adjusted hazard ratio [HR]1.53, 95% confidence interval [CI] 0.89-2.45, P=0.12), but it was an independent predictor of MACCE in the long term (adjusted HR 2.18, 95% CI 1.39-3.42, P=0.001).Conclusion: In patients undergoing elective surgical revascularization, left coronary dominance is associated with increased MACCE risk in the long term. Therefore, the assessment of coronary dominance type should be an integral part of outpatient management after CABG.

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Advances in Clinical Cardiology 2022: A Summary of Key Clinical Trials

et al. 2023

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Introduction: Over the course of 2022, numerous key clinical trials with valuable contributions to clinical cardiology were published or presented at major international conferences. This review seeks to summarise these trials and to reflect on their clinical context. Methods: The authors reviewed clinical trials presented at major cardiology conferences during 2022, including the American College of Cardiology (ACC), European Association for Percutaneous Cardiovascular Interventions (EuroPCR), European Society of Cardiology (ESC), Transcatheter Cardiovascular Therapeutics (TCT), American Heart Association (AHA), European Heart Rhythm Association (EHRA), Society for Cardiovascular Angiography and Interventions (SCAI), TVT-The Heart Summit (TVT) and Cardiovascular Research Technologies (CRT). Trials with a broad relevance to the cardiology community and those with potential to change current practice were included. Results: A total of 93 key cardiology clinical trials were identified for inclusion. Interventional cardiology data included trials evaluating the use of new generation novel stent technology and new intravascular physiology strategies such as quantitative flow ratio (QFR) to guide revascularisation in stable and unstable coronary artery disease. New trials in acute coronary syndromes and intervention focused on long-term outcomes of optimal medical therapy (OMT), revascularisation in ischaemic dysfunction and left main (LM) intervention. Structural intervention trials included latest data on optimal timing and anticoagulation strategies in transcatheter aortic valve replacement (TAVR), in addition to expanding evidence in mitral and tricuspid valve interventions. Heart failure data included trials with sodium-glucose cotransporter 2 (SGLT2) inhibitors, iron replacement and novel drugs such as omecamtiv. Prevention trials included new data on proprotein convertase subtilisin/ kexin type 9 (PCSK9) inhibitors and polypill strategies. In electrophysiology, new data regarding optimal timing of ablative therapy for atrial fibrillation (AF) in addition to novel screening strategies were evaluated. Conclusion: This article presents a summary of key clinical cardiology trials published and presented during the past year and should be of interest to both practising clinicians and researchers.

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Effect of coronary dominance on 2‐year outcomes after percutaneous coronary intervention in patients with acute coronary syndrome

Abstract: LD was an independent predictor of long-term mortality in ACS patients undergoing PCI. The effect of LD still existed after adjustment for several important variables and was independent of SYNTAX score. © 2017 Wiley Periodicals, Inc.

Cited by 6 publications

References 18 publications

Effect of Coronary Artery Dominance In-terms of Presentation and In-hospital Outcomes of patients undergoing Primary PCI for Culprit Proximal Left Anterior Descending Artery

Effect of Coronary Artery Dominance In-terms of Presentation and In-hospital Outcomes of patients undergoing Primary PCI for Culprit Proximal Left Anterior Descending Artery

Prognostic Value of Coronary Dominance in Patients Undergoing Elective Coronary Artery Bypass Surgery

Advances in Clinical Cardiology 2022: A Summary of Key Clinical Trials

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