Abstract 14713: Coronary Dominance and Risk of Ventricular Fibrillation in Coronary Artery Disease

Abstract

Introduction: Recent studies have suggested a link between coronary dominance and overall prognosis in patients with coronary artery disease (CAD). A specific association with sudden cardiac arrest (SCA) has not been investigated. Hypothesis: Coronary dominance pattern is associated with SCA risk. Methods: From a large, prospective, population-based study of SCA in a Northwestern US metro region (approx. one million residents), we identified SCA cases who underwent coronary angiogram at cardiac arrest and compared the coronary dominance pattern to a geographically-matched control population without history of SCA, undergoing angiograms for acute coronary syndromes (ACS) over the same time period. Results: Angiographic data were compared between a total of 203 SCA cases and 173 control subjects. Cases and controls respectively were not significantly different in age (62.3± 12.4 vs 64.3 ± 10.9 years; p=0.09), sex (males 69.8% vs 71.7%, p=0.69), body mass index (29.0 ± 7.7 vs 29.1 ± 6.6; p=0.89), diabetes (33.5% vs 27.9%; p=0.24), hypertension (62.5% vs 65.7%; p=0.52) and previous history of myocardial infarction (36.0% vs 34.9%; p=0.82) or coronary revascularization (18.7% vs 25.4%; p=0.12). Ventricular tachycardia or fibrillation (VT/VF) was the presenting arrest rhythm in the majority (86.9%) of cases. Compared to controls, a right dominant coronary system was less likely to be seen in cases (78.4% vs 86.7%) and a co-dominant system was more likely to be present (9.9% vs 1.9%) with nearly equal left dominance (11.7% vs 11.4%) (p for between group comparisons = 0.04). A co-dominant system was associated with an increased odds of SCD [OR 5.6 (1.2-26.2); p=0.01].There was no difference in the proportion of cases and controls with significant stenosis (≥ 50%) in the posterior descending artery (4.4% vs 8.7%; p=0.10). Conclusions: In this community-based study, we identified specific patterns of coronary dominance associated with VF. Mechanisms related to the area of myocardium at risk or vascular supply to the inferior (vagal) surface of the heart may be involved and warrant further focused evaluation.