Influence of coronary vessel dominance on short- and long-term outcome in patients after ST-segment elevation
Caroline E Veltman1, Bas L van der Hoeven2, Georgette E Hoogslag2
1Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands The Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.
Insights
Left dominant coronary systems increase early mortality and reinfarction risk in ST-elevation myocardial infarction (STEMI) patients. Coronary vessel dominance does not impact long-term outcomes after surviving the initial 30 days post-STEMI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Coronary vessel dominance is a known anatomical variation.
- Its prognostic significance in ST-elevation myocardial infarction (STEMI) is not well-established.
- Understanding this relationship can refine risk stratification and patient management.
Purpose of the Study:
- To investigate the impact of coronary vessel dominance on short- and long-term outcomes in patients with STEMI.
- To determine if left dominance, right dominance, or a balanced system influences mortality and reinfarction rates.
Main Methods:
- Retrospective review of coronary angiographic images from 1131 STEMI patients.
- Assessment of coronary vessel dominance (right, left, or balanced).
- Follow-up for a median of 48 months to record all-cause mortality and composite of reinfarction and cardiac death.
Main Results:
- Left dominant systems were found in 9% of patients, right dominant in 86%, and balanced in 5%.
- Left dominance was associated with significantly higher 5-year all-cause mortality (log-rank P = 0.013).
- Left dominance independently predicted increased 30-day mortality (OR 2.51) and early composite events (OR 2.25).
Conclusions:
- A left dominant coronary artery system is linked to a higher risk of 30-day mortality and early reinfarction post-STEMI.
- Coronary vessel dominance did not affect long-term outcomes in patients who survived the initial 30 days.
- Left dominance is a significant independent predictor of short-term adverse events following STEMI.
Aims:
Prognostic importance of coronary vessel dominance in patients with ST-elevation myocardial infarction (STEMI) remains uncertain. The aim of this study was to assess influence of coronary vessel dominance on the short- and long-term outcome after STEMI.
Methods And Results:
Coronary angiographic images of consecutive patients presenting with first STEMI were retrospectively reviewed to assess coronary vessel dominance. Patients were followed after STEMI during a median period of 48 (IQR38-61) months for the occurrence of all-cause mortality and the composite of reinfarction and cardiac death. The population comprised 1131 patients of which 971 (86%) patients had a right dominant, 102 (9%) a left dominant, and 58 (5%) a balanced system. After 5 years of follow-up, the cumulative incidence of all-cause mortality was significantly higher in patients with a left dominant system, compared with a right dominant and balanced system (log-rank P = 0.013). Moreover, a left dominant system was an independent predictor for 30-day mortality (OR 2.51, 95% CI 1.11-5.67, P = 0.027) and the composite of reinfarction and cardiac death within 30-days after STEMI (OR 2.25, 95% CI 1.09-4.61, P = 0.028). In patients surviving first 30-days post-STEMI, coronary vessel dominance had no influence on long-term outcome.
Conclusions:
A left dominant coronary artery system is associated with a significantly increased risk of 30-day mortality and early reinfarction after STEMI. After surviving the first 30-days post-STEMI, coronary vessel dominance had no influence on long-term outcome.
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