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Prognostic Value of Coronary Dominance in Patients Undergoing Elective Coronary Artery Bypass Surgery
Emre Selcuk1, Deniz Cevirme2, Onursal Bugra3
1Department of Cardiovascular Surgery, Mus State Hospital, Muş, Turkey.
Insights
Left coronary dominance (LD) in patients undergoing coronary artery bypass grafting (CABG) is linked to higher long-term risks of major adverse cardiac and cerebrovascular events (MACCE). Assessing coronary dominance is crucial for post-CABG patient management.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Medicine
Background:
- Coronary artery dominance describes the main source of blood supply to the heart's arteries.
- Understanding coronary dominance is important for surgical planning and predicting outcomes in patients undergoing coronary artery bypass grafting (CABG).
Purpose of the Study:
- To assess the clinical impact of coronary dominance type on early and long-term outcomes after elective CABG.
- To determine if left dominance is associated with adverse events post-CABG.
Main Methods:
- A cohort of 844 patients undergoing elective CABG were classified into left dominant (LD) or right dominant/co-dominant (RD+CD) groups based on preoperative angiography.
- Outcomes evaluated included postoperative complications, 30-day mortality, long-term mortality, and major adverse cardiac and cerebrovascular events (MACCE).
Main Results:
- Left dominance (LD) was identified in 12.1% of patients.
- No significant differences were observed in postoperative complications, 30-day mortality, or readmissions between LD and RD+CD groups.
- Long-term follow-up (median 3.4 years) revealed LD as an independent predictor of MACCE (adjusted HR 2.18, P=0.001), but not overall mortality.
Conclusions:
- Left coronary dominance is associated with an increased risk of long-term MACCE in patients undergoing elective CABG.
- Coronary dominance assessment should be integrated into the outpatient management of patients post-CABG to identify those at higher risk.
Objective:
To evaluate the clinical impact of coronary dominance type in terms of early and long-term outcomes in patients undergoing elective coronary artery bypass grafting (CABG).
Methods:
A total of 844 consecutive patients who underwent elective CABG were divided into two groups based on preoperative angiographic views as left dominant (LD) and right dominant or co-dominant (RD+CD). The measured outcomes were postoperative complications, 30-day mortality, long-term mortality, and major adverse cardiac and cerebrovascular events (MACCE).
Results:
RD+CD was present in 87.9% (n=742) and LD in 12.1% (n=102) of patients. Postoperative complications, 30-day mortality, and 30-day readmissions were similar in both groups. The median duration of follow-up was 3.4 years. LD was not an independent predictor of mortality (adjusted hazard ratio [HR] 1.53, 95% confidence interval [CI] 0.89-2.45, P=0.12), but it was an independent predictor of MACCE in the long term (adjusted HR 2.18, 95% CI 1.39-3.42, P=0.001).
Conclusion:
In patients undergoing elective surgical revascularization, left coronary dominance is associated with increased MACCE risk in the long term. Therefore, the assessment of coronary dominance type should be an integral part of outpatient management after CABG.
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