Key result
Left coronary artery dominance in patients with STEMI was associated with lower left ventricular ejection fraction and worse TIMI flow, but did not significantly affect PCI success, complications, or 1-year mortality.
Why the study?
The effect of coronary artery dominance on clinical outcomes following primary PCI in patients with STEMI is not fully investigated.
Does left or codominant coronary artery circulation worsen complications and 1-year mortality in STEMI patients undergoing primary PCI compared to right dominance?
Cross-Sectional (n=110)
Yes
Does left or codominant coronary artery circulation worsen complications and 1-year mortality in STEMI patients undergoing primary PCI compared to right dominance?
p-value: p=>0.05
While left coronary dominance in STEMI patients is associated with worse angiographic flow (TIMI ≤2) and lower LVEF, it does not significantly impact 1-year mortality or procedural complications compared to right dominance.
Coronary dominance should not guide PCI decisions in STEMI; leaves open prospective evaluation of LVEF and flow associations.
Background: Percutaneous coronary intervention (PCI) is the treatment of choice for patients with ST-segment elevation myocardial infarction (STEMI). Effect of coronary artery dominance on the patients' outcome following primary PCI (PPCI) is not fully investigated. We investigated the association of coronary artery dominance with complications and 1-year mortality rate of PPCI. Materials and Methods: In this retrospective study, patients with STEMI treated with PPCI from March 2016 to February 2018 were divided into three groups based on their coronary dominancy: left dominance (LD), right dominance (RD), and codominant. Demographic characteristics, medical history, results of physical examination, electrocardiography, angiography, and echocardiography were compared between the groups. Results: Of 491 patients included in this study, 34 patients (7%) were LD and 22 patients (4.5%) were codominant. Accordingly, 54 propensity-matched RD patients were included in the analysis. The demographics and comorbidities of the three groups were not different (P > 0.05); however, all patients in the RD group had thrombolysis in myocardial infarction (TIMI) 3, while five patients in the LD and five patients in the codominant group had a TIMI ≤2 (P = 0.006). At admission, the median left ventricular ejection fraction (LVEF) was highest in RD patients and lowest in LD and codominant patients (34%, P = 0.009). There was no difference in terms of success or complications of PCI, in-hospital, and 1-year mortality rate (P > 0.05). Conclusion: Patients with left coronary artery dominance had a higher value of indicators of worse outcomes, such as lower LVEF and TIMI ≤ 2, compared with RD patients, but not different rates of success or complications of PCI, in-hospital, and 1-year mortality. This finding may suggest that interventionists should prepare themselves with protective measures for no-reflow and slow-flow phenomenon and also mechanical circulatory support before performing PPCI in LD patients.
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Abdi‐Ardekani et al. (2020) conducted a cross-sectional in ST-segment elevation myocardial infarction (STEMI) (n=110). Left coronary artery dominance vs. Right coronary artery dominance was evaluated on Complications of PCI, in-hospital, and 1-year mortality rate (p=>0.05). Left coronary artery dominance in patients with STEMI was associated with lower left ventricular ejection fraction and worse TIMI flow, but did not significantly affect PCI success, complications, or 1-year mortality.
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