Impact of Coronary Dominance on In-Hospital Outcomes after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome

Abstract

ObjectiveThis study evaluated the manner in which coronary dominance affects in-hospital outcomes of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).BackgroundPrevious studies have shown that left dominant coronary anatomies are associated with worse prognoses in patients with coronary artery disease.MethodsData were analyzed from 4873 ACS patients undergoing PCI between September 2008 and April 2013 at 14 hospitals participating in the Japanese Cardiovascular Database Registry. The patients were grouped based on diagnostic coronary angiograms performed prior to PCI; those with right- or co-dominant anatomy (RD group) and those with left-dominant anatomy (LD group).ResultsThe average patient age was 67.6±11.8 years and both patient groups had similar ages, coronary risk factors, comorbidities, and prior histories. The numbers of patients presenting with symptoms of heart failure, cardiogenic shock, or cardiopulmonary arrest were significantly higher in the LD group than in the RD group (heart failure: 650 RD patients [14.7%] vs. 87 LD patients [18.8%], P = 0.025; cardiogenic shock: 322 RD patients [7.3%] vs. 48 LD patients [10.3%], P = 0.021; and cardiopulmonary arrest: 197 RD patients [4.5%] vs. 36 LD patients [7.8%], P = 0.003). In-hospital mortality was significantly higher among LD patients than among RD patients (182 RD patients [4.1%] vs. 36 LD patients [7.8%], P = 0.001). Multivariate logistic regression analysis revealed that LD anatomy was an independent predictor for in-hospital mortality (odds ratio, 1.75; 95% confidence interval, 1.06–2.89; P = 0.030).ConclusionAmong ACS patients who underwent PCI, LD patients had significantly worse in-hospital outcomes compared with RD patients, and LD anatomy was an independent predictor of in-hospital mortality.

Association of Left Coronary Dominance with In- Hospital Adverse Outcomes after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome

“…One of the study in abroad showed that diagnosis of ACS patients between the RD+Co and LD group had no statistically significant difference. 6 Normal weight had found more in LD group (50%) than RD + Co group (30.1%). On the other hand, overweight had found more in RD + Co group (63.4%) than LD group (46.2%).…”

“…One of the study in abroad showed that left ventricular failure was more (18.8%) in LD group than RD+Co (14.7%) group and cardiogenic shock was more (10.3%) in LD group than RD+Co (7.3%) group. 6 There was one death in patients with RD+Co group. This patient was dead due to early stent thrombosis.…”

“…One of the study was found that adverse in-hospital outcome was more (15.1%) in LD group than RD+Co group (13.6%). 6 The higher in-hospital adverse outcome associated with LD patients due to RCA serves as a back-up supply in patients with RD anatomy, providing a measure of protection for the myocardium in ACS patients. Lower left ventricular ejection fractions and larger infarct size is another reason affecting inhospital adverse outcome for LD patients.…”

“…In these individuals, the left circumflex artery (LCX) reaches the crux and supplies the posterior descending and, usually, the atrioventricular nodal branches. 6 Left and codominance are generally considered to be normal variants with no particular prognostic significance. However, the relatively low prevalence of left and codominance may reflect a small biologic disadvantage relative to right dominance.…”

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

“…In a Canadian study, which enrolled 27289 ACS patients undergoing PCI, LD was found to a significant and independent predictor of increased long‐term mortality . Kuno et al also demonstrated that LD patients have a higher in‐hospital mortality than RD or co‐dominance patients in a Japanese population . The reason for worse outcomes in LD patients is not clear.…”