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

Gebhard, Cathérine; Gick, Michael; Ferenc, Mirosław; Stähli, Barbara E.; Ademaj, Fadil; Mashayekhi, Kambis; Buettner, Heinz Joachim; Neumann, Franz‐Josef; Toma, Aurel

doi:10.1002/ccd.27174

Cited by 9 publications

(8 citation statements)

References 38 publications

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“…Prior studies [10, 34] have focused on patients with both RCA-CTO and other severe situations (older age, unprotected left main artery) and reported a higher incidence of mortality or cardiac mortality. A smaller RCA (left coronary dominance) is also a predictor of all-cause death in CTO patients [35]. Thus, the importance of RCA will be more obvious in patients with other severe conditions.…”

Section: Discussionmentioning

confidence: 99%

Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study

Yan

Zhang

Yuan

et al. 2019

Cardiovasc Diabetol

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Background The territory of the right coronary artery (RCA) is smaller than that of the left anterior descending artery. Previous studies have reported conflicting results when considering whether stable RCA-chronic total occlusion (CTO) should be reopened. The coexistence of diabetic and coronary artery diseases represents a severe situation. Therefore, we aimed to determine if stable RCA-CTO in diabetic patients was necessary to be reopened. To our knowledge, no studies have focused on this topic to date. Methods We enrolled diabetic patients with RCA-CTO who had clinical presentations of symptomatic stable angina or silent ischemia. RCA-CTO was treated with either successful revascularization (the CTO-SR group) or medical therapy (the CTO-MT group). The primary endpoint was all-cause death. Both Cox regression and propensity score matching analyses were used. Sensitivity analysis was performed based on subgroup populations and relevant baseline variables. Results A total of 943 patients were included: 443 (46.98%) patients in the CTO-MT group and 500 (53.02%) patients in the CTO-SR group. After a mid-term follow-up (CTO-SR: 48 months; CTO-MT: 42 months), we found that CTO-SR was superior to CTO-MT in terms of all-cause death (adjusted hazard ratio [HR] [model 1]: 0.429, 95% conference interval [CI] 0.269–0.682; adjusted HR [model 2]: 0.445, 95% CI 0.278–0.714). The superiority of CTO-SR was consistent for cardiac death, possible/definite cardiac death, repeat revascularization, target vessel revascularization (TVR) and repeat nonfatal myocardial infarction. Subgroup analysis confirmed the mortality benefit of CTO-SR by percutaneous coronary intervention (the successful CTO-PCI subgroup, 309 patients in total). While CTO-SR by coronary artery bypass grafting (the CTO-CABG subgroup, 191 patients in total) offered patients more benefit from repeat revascularization and TVR than that offered by successful CTO-PCI. Conclusions For stable RCA-CTO patients with diabetes, successful revascularization offered patients more clinical benefits than medical therapy. CTO-CABG might be a more recommended way to accomplish revascularization. Trial registration This study was not registered in an open access database Electronic supplementary material The online version of this article (10.1186/s12933-019-0911-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study

Yan

Zhang

Yuan

et al. 2019

Cardiovasc Diabetol

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“…According to several studies, left coronary dominance has been identified as a poor prognostic factor for not only patients with ACS, but also for patients who underwent elective percutaneous coronary intervention [3,4] . LD patients with ACS have been shown to be hemodynamically more unstable both before and after intervention than non-LD patients [8] .…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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“…A left dominant system has been shown to be an independent risk factor of morbidity and mortality in patients who underwent both surgical and percutaneous revascularization, particularly in patients with ST-segment elevated myocardial infarction (STEMI) [2][3][4]. In addition, LD is shown to be an independent predictor of increased all-cause death and MACE in patients with chronic total occlusion (CTO) [5]. Therefore, an assessment of coronary vessel dominance by angiography could contribute to risk stratification in patients with coronary artery disease.…”

Section: Introductionmentioning

confidence: 99%

Koroner arteriyel baskınlık ve QRS ekseni arasındaki ilişki

Korkmaz

2019

Turkish Journal of Clinics and Laboratory

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Aim: Coronary artery dominance influences the amount and anatomic location of myocardium that is perfused by the left or right coronary circulation. However, the association between coronary arterial dominance and the QRS axis on 12-lead surface electrocardiography (ECG) was not investigated. The present study aims to evaluate the relationship between coronary arterial dominance and the QRS axis on ECG in patients without significant coronary artery and structural cardiac disease. Material and Methods:Overall, 133 patients, without significant CAD and who met the inclusion criteria, participated in this study. A standard surface 12-lead ECGs were performed in all study patients. QT interval, QTc interval, QRS duration, PR interval, P wave and QRS axis were determined. Based on the origin of the posterior descending coronary artery, coronary circulation was categorised into left, right, and balanced coronary dominance.Results: There were 133 subjects with 56 right dominant (42%), 39 left dominant (29%) and 38 codominant (29%) pattern.QRS axis value was found to be significantly higher in the left dominant group when compared with the codominant and right dominant group (p<0.05). No significant difference was observed between the codominant and right dominant groups regarding QRS axis values. The axis of (+30)-(+90) ratio in the left dominant group was found to be significantly higher when compared with the codominant and right dominant group (p<0.05). No significant difference was observed between the codominant and right dominant groups regarding the axis of (+30)-(+90) ratio. Conclusion:Our findings suggested that the QRS axis may be related to coronary artery dominance.

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

Cited by 9 publications

References 38 publications

Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study

Successful revascularization versus medical therapy in diabetic patients with stable right coronary artery chronic total occlusion: a retrospective cohort study

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

Koroner arteriyel baskınlık ve QRS ekseni arasındaki ilişki

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