Key result
Left coronary artery dominance is linked to higher 3-month risk of major cardiovascular events.
Why the study?
Limited information is available regarding the relationship between coronary vessel dominance and outcome after STEMI treated with primary PCI.
Does left coronary arterial dominance increase the risk of adverse clinical events in STEMI patients undergoing primary PCI?
Cohort (n=300)
No
Does left coronary arterial dominance increase the risk of adverse clinical events in STEMI patients undergoing primary PCI?
In STEMI patients treated with primary PCI, left coronary artery dominance is associated with a higher risk of adverse clinical events and lower LVEF compared to right or balanced dominance.
Supports incorporating coronary dominance into STEMI risk assessment; leaves open whether it alters PCI strategy or requires prospective validation.
BACKGROUND: Limited information is available regarding the relationship between coronary vessel dominance and outcome after ST-segment elevation myocardial infarction (STEMI). OBJECTIVES: The study was designed to evaluate the prognostic value of coronary arterial dominance after primary percutaneous coronary intervention (PCI) during hospital stay and at 3 months follow-up regarding cardiac mortality, heart failure, nonfatal myocardial infarction, revascularization, and stroke. PATIENTS AND METHODS: The study population consisted of 300 consecutive patients (mean age, 57.35 ± 13.41 years; 91% men) with STEMI who were admitted to Dallah Hospital (Riyadh, Saudi Arabia) from January 2015 to December 2016. These patients underwent successful primary PCI with thrombolysis in myocardial infarction (TIMI) III flow. They were divided into three groups according to angiographic coronary dominance: 227 (75.7%) in the right coronary dominant group, 40 (13.3%) in the left coronary dominant group, and 33 (11%) in the balanced coronary dominant group. They were evaluated with two- (2D) and three-dimensional (3D) echocardiography within 48 hours of admission and at 3 months follow-up after STEMI. RESULTS: Right dominance was present in 75.6%, left dominance in 13.3%, and balanced dominance was present in 11% of patients. The main finding of this study was that a left dominant system was associated with increased risk of cardiac mortality, heart failure, nonfatal myocardial infarction, revascularization, and stroke shortly after primary PCI, during hospital stay, and at 3 months follow-up after STEMI. Moreover, a significantly lower left ventricular ejection fraction at admission was observed by both 2D and 3D echocardiography in patients with a left dominant system. CONCLUSION: In patients with STEMI treated with primary PCI, left coronary artery dominance confers a higher risk of various adverse clinical events after primary PCI, during hospital stay, and at 3 months follow-up compared to right and balanced coronary artery dominance.
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Hanboly et al. (2018) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=300). Left coronary arterial dominance vs. Right and balanced coronary arterial dominance was evaluated on Cardiac mortality, heart failure, nonfatal myocardial infarction, revascularization, and stroke. Left coronary artery dominance (present in 13.3% of patients) was associated with an increased risk of cardiac mortality, heart failure, nonfatal MI, revascularization, and stroke at 3 months.
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