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.
Highlights
Variations in the balance of the coronary arteries are common, with regard to the supply of the posterior aspect of the left ventricle
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
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)
Summary
Variations in the balance of the coronary arteries are common, with regard to the supply of the posterior aspect of the left ventricle. In the majority of patients, the right coronary artery (RCA) reaches the crux of the heart and supplies the posterior descending artery (PDA) [1]. Left-dominant (LD) anatomy, described as a variant of normal anatomy, has a prevalence of approximately 5–12% in the general population [2,3,4,5]. In these individuals, the left circumflex artery (LCX) reaches the crux and supplies the posterior descending and, usually, the atrioventricular nodal branches [2]. Previous studies have shown that left dominant coronary anatomies are associated with worse prognoses in patients with coronary artery disease
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