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Coronary dominance and prognosis in patients with chronic total occlusion treated with percutaneous coronary

Cathérine Gebhard1, Michael Gick1, Miroslaw Ferenc1

  • 1Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Germany.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|August 11, 2017
PubMed

Insights

Left coronary dominance in patients with chronic total occlusions (CTO) undergoing percutaneous coronary intervention (PCI) is linked to higher mortality. Coronary artery dominance assessment aids risk stratification for CTO patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • The prognostic implications of coronary artery dominance patterns in patients with chronic total occlusions (CTOs) remain unclear.
  • Understanding these patterns is crucial for optimizing treatment strategies and patient outcomes in interventional cardiology.

Purpose of the Study:

  • To evaluate the impact of coronary vessel dominance on short- and long-term outcomes.
  • To assess the prognostic value of left, right, and balanced coronary dominance in patients undergoing percutaneous coronary intervention (PCI) for CTO.

Main Methods:

  • A cohort of 2002 patients undergoing PCI for at least one CTO lesion between 2005 and 2013 was analyzed.
  • Coronary artery dominance was categorized based on the origin of the posterior descending coronary artery.
  • Outcomes including all-cause mortality and major adverse cardiac events (MACE) were assessed at a median follow-up of 2.6 years.

Main Results:

  • Right coronary dominance (RD) was observed in 88%, left coronary dominance (LD) in 7%, and balanced dominance (BD) in 5% of patients.
  • Patients with LD exhibited significantly higher all-cause mortality compared to those with RD and BD (log rank = 0.001).
  • LD was identified as an independent predictor of all-cause mortality (aHR 1.7) and MACE (aHR 1.4).

Conclusions:

  • Left coronary dominance is an independent predictor of increased all-cause death and MACE in patients with CTO.
  • Coronary angiography assessment of vessel dominance can enhance risk stratification for patients with CTO undergoing PCI.
Abstract

Keywords:
angiographycoronary artery chronic total occlusioncoronary dominancepercutaneous coronary intervention

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