Meta-Analysis Evaluating the Effect of Left Coronary Dominance on Outcomes After Percutaneous Coronary Intervention
Muhammad Shahzeb Khan1, Muhammad Shariq Usman2, Tauseef Akhtar1
1Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, Illinois.
Insights
Patients with left coronary dominance (LD) face higher mortality risks after percutaneous coronary intervention (PCI). This meta-analysis confirms LD is linked to increased in-hospital, 30-day, and long-term death rates following PCI procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Statistics
Background:
- The prognostic significance of coronary circulation dominance, particularly left coronary dominance (LD), in patients undergoing percutaneous coronary intervention (PCI) remains a subject of debate.
- Understanding the impact of coronary anatomy variations on PCI outcomes is crucial for risk stratification and treatment planning.
Purpose of the Study:
- To conduct a comprehensive meta-analysis assessing the association between left coronary dominance (LD) and clinical outcomes in patients who have undergone percutaneous coronary intervention (PCI).
- To pool existing evidence to clarify the prognostic value of LD in the context of PCI.
Main Methods:
- A systematic literature search was performed across MEDLINE, Cochrane CENTRAL, and Scopus databases.
- Included were observational studies and randomized controlled trials investigating the link between coronary dominance and PCI outcomes.
- Data from nine studies, encompassing 266,119 patients, were pooled using a random effects model to calculate odds ratios (OR) and 95% confidence intervals.
Main Results:
- Left coronary dominance (LD) was significantly associated with increased odds of in-hospital (OR: 1.54), 30-day (OR: 2.16), and long-term mortality (OR: 1.83) post-PCI.
- Patients with LD also showed a higher incidence of major adverse cardiac events (OR: 1.27) and failed PCI (OR: 1.30).
- No significant differences were observed in stent thrombosis or reinfarction rates between LD and non-LD groups.
Conclusions:
- This meta-analysis indicates that patients with left coronary dominance (LD) exhibit a significantly elevated risk of mortality following percutaneous coronary intervention (PCI) when compared to those with non-LD anatomy.
- The findings underscore the importance of considering coronary anatomy in the risk assessment and management of patients undergoing PCI.
Abstract:
Prognostic significance of coronary circulation dominance remains controversial. The primary objective of this meta-analysis was to pool all the available evidence to assess the influence of left coronary dominance (LD) on outcomes in patients who underwent percutaneous coronary intervention (PCI). MEDLINE, Cochrane CENTRAL, and Scopus databases were searched for all observational studies and randomized controlled trials that investigated the association between coronary dominance and outcomes in patients who underwent PCI. Odds ratios (OR) and 95% confidence intervals from individual studies were pooled using a random effects model. A total of nine studies including 266,119 patients were included. On pooled analysis, it was noted that LD was associated with significantly increased odds of in-hospital (OR: 1.54 [1.12, 2.11]; p = 0.007), 30-day (OR: 2.16 [1.22, 3.84]; p = 0.008), and long-term mortality (OR: 1.83 [1.33 to 2.50]; p < 0.001). LD patients also experienced a significantly higher incidence of major adverse cardiac events (OR: 1.27 [1.03, 1.58]; p = 0.03) and failed PCI (OR: 1.30 [1.03, 1.65]; p = 0.03). In contrast, no significant difference was noted between LD and non-LD patients in the incidence of stent thrombosis (OR: 1.28 [0.55, 3.01]; p = 0.57; I2 = 0%) or reinfarction (OR: 1.73 [0.90, 3.35]; p = 0.10; I2 = 63%). In conclusion, this meta-analysis suggests that patients with LD coronary anatomy are at significantly increased risk for mortality after PCI compared with patients with a non-LD anatomy.
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