Prognostic Value of Anatomical Dominance of Coronary Circulation in Patients with Surgical Myocardial Revascularization

Omerbašić, Edin; Hasanović, Aida; Omerbasic, A.; Pandur, Sanko

doi:10.5455/medarh.2015.69.6-9

Cited by 9 publications

(9 citation statements)

References 17 publications

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“…Previous studies have demonstrated a close link between left coronary artery dominance and ACS or significant CAD [23–25]. Left dominance has been identified as a predictor of non-fatal MI and all-cause mortality in patients with significant CAD [13].…”

Section: Discussionmentioning

confidence: 99%

Association between coronary dominance and acute inferior myocardial infarction: a matched, case-control study

Wang

Gao

et al. 2019

BMC Cardiovasc Disord

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BackgroundPrevious studies have found a connection between left coronary artery dominance and worse prognoses in patient with acute coronary syndrome, which remains a predominant cause of morbidity and mortality globally. The aim of this study was to investigate whether coronary dominance is associated with the incidence of acute inferior myocardial infarction (MI).MethodsBetween January 2011 and November 2014, 265 patients with acute inferior MI and 530 age-matched and sex-matched controls were recruited for a case-control study in the Second Affiliated Hospital of Xi’an Jiaotong University in Xi’an, China. All participants underwent coronary angiography. The exclusion criteria included history of coronary artery bypass graft surgery, chronic or systemic diseases (including hepatic failure, kidney failure, hypothyroidism and Grave’s disease), ventricular fibrillation, and known allergy to iodinated contrast agent. Patients with left- or co-dominant anatomies were placed into the LD group and those with right-dominant anatomy were included in the RD group. The association of acute inferior MI and coronary dominant anatomy were assessed using multivariable conditional logistic regression, and to estimate the odds ratio (OR) and 95% confidence interval (95%CI).ResultsDistributions of right dominance were significantly different between the acute inferior MI group and control group (94.0% vs. 87.9%, P = 0.018). Univariable conditional logistic regression revealed that right dominance may be a risk factor for the incident acute inferior MI (OR: 2.137; 95% CI: 1.210–3.776; P = 0.009). After adjusting for baseline systolic blood pressure, heart rate, smoking status, diabetes mellitus, hypertension, hyperlipidaemia, and family history of coronary artery disease, results of multivariate conditional logistic regression showed that right dominance was associated with the incidence of acute inferior MI (OR: 2.396; 95% CI: 1.328–4.321; P = 0.004).ConclusionsRight coronary dominance may play a disadvantageous role in the incidence of acute inferior MI. However, further studies are needed to verify our findings, especially with regard to the underlying mechanisms.

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Section: Discussionmentioning

confidence: 99%

Association between coronary dominance and acute inferior myocardial infarction: a matched, case-control study

Wang

Gao

et al. 2019

BMC Cardiovasc Disord

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“…In a co-dominant system, the supply of posterior IV septum is shared by both RCA and LCX[3]. Right dominant system is the more prevalent variant occurring in approximately 70% of people, followed by left dominant and co-dominant system[4]. …”

Section: Introductionmentioning

confidence: 99%

“…Left dominant system has been shown to be an independent risk factor of morbidity and mortality in patients undergoing both surgical and percutaneous revascularization, especially in patients with ST segment elevated myocardial infarction (STEMI)[4-7]. …”

Section: Introductionmentioning

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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“…We called this technique, the SMR. Due to cardiac characteristics in pigs, the development of the model of SMR required a rigorous surgical learning curve to safely access the ascending aorta and achieve a selective retrograde perfusion of the great cardiac vein [8,9,[25][26][27]. The capacity of SMR to produce inotropic effects when associated with a simultaneous antegrade perfusion, was previously reported by us in a preliminary experience with OPCAB surgery [14].…”

Section: Discussionmentioning

confidence: 99%

Evidences for Inotropism Triggered by Simultaneous Antegrade And Retrograde Myocardial Perfusion in A Swine Model

Grandmougin¹

2019

JICOA

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Keywords:Self Myocardial Retroperfusion (SMR) coronary Circulation left azygos vein inotropism hemodynamics conductance catheter A B S T R A C T Objectives: Retrograde perfusion into the coronary sinus is currently used to deliver cardioplegia. We developed an in-vivo porcine beating-heart model of self-myocardial retroperfusion (SMR) using the venous route to increase myocardial oxygenation of the left ventricle. Then, we sought to assess whether the association of a simultaneous antegrade and retrograde myocardial perfusion with oxygenated blood might trigger hemodynamic and cardiac responses compared with a single antegrade myocardial supply.Methods: A group of 8 pigs was dedicated to undergo SMR with a simultaneous antegrade physiological LAD perfusion. SMR was achieved with a bypass-line between the ascending aorta and the coronary sinus to perform a selective retrograde perfusion of the great cardiac vein with oxygenated blood after ligation of the left azygos vein.Cardiac output (CO), maximal pressure in the LV (Pmax in-LV), stroke volume (SV), left ventricular ejection fraction (LVEF), diastolic durations, heart rate (HR), and arterial systemic pressure were monitored with conductance catheters. These data were collected during the antegrade myocardial perfusion (baseline period) and compared with data recorded during a simultaneous antegrade and retrograde perfusion. At the end of the procedures, the hearts were harvested for histology.Results: SMR with antegrade LAD perfusion showed inotropic properties with significant improvements in CO, SV, Pmax in-LV and LVEF (p<0.0001) compared with baseline values. Histology confirmed no signs of tissular injuries. Conclusions:The selective retrograde perfusion of the great cardiac vein with oxygenated blood combined with an antegrade physiological LAD perfusion showed obvious capacities to trigger inotropic properties opening interesting perspectives.

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Prognostic Value of Anatomical Dominance of Coronary Circulation in Patients with Surgical Myocardial Revascularization

Cited by 9 publications

References 17 publications

Association between coronary dominance and acute inferior myocardial infarction: a matched, case-control study

Association between coronary dominance and acute inferior myocardial infarction: a matched, case-control study

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

Evidences for Inotropism Triggered by Simultaneous Antegrade And Retrograde Myocardial Perfusion in A Swine Model

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