Difference in outcomes between right and left posterior descending artery percutaneous coronary intervention: an
Muhtasim Rahman Zahin1, Riley Batchelor2, Angela Brennan3
1Royal Melbourne Hospital, Melbourne, Australia. muhtasim178@gmail.com.
Insights
Coronary artery disease patients undergoing percutaneous coronary intervention (PCI) for the posterior descending artery (PDA) showed similar outcomes regardless of left-dominant or right-dominant coronary anatomy. This study found no association between coronary dominance and clinical outcomes in PDA PCI procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Percutaneous coronary intervention (PCI) is a key treatment for coronary artery disease.
- Coronary dominance, particularly left-sided posterior descending artery (L-PDA) PCI, may present greater complexity and risk compared to right-sided PDA (R-PDA) PCI.
- Understanding these differences is crucial for procedural planning and patient outcomes.
Purpose of the Study:
- To compare the characteristics and clinical outcomes of PCI procedures involving L-PDA versus R-PDA.
- To investigate the impact of coronary dominance on procedural risk and patient outcomes in PDA interventions.
Main Methods:
- Retrospective analysis of a statewide registry (Victorian Cardiac Outcomes Registry) from 2013 to 2022.
- Inclusion of patients undergoing PCI for L-PDA and R-PDA lesions.
- Comparison of patient demographics, comorbidities, and 30-day mortality and major adverse cardiac events (MACE).
Main Results:
- A total of 2,880 patients were analyzed: 2,282 (79.2%) for R-PDA PCI and 598 (20.8%) for L-PDA PCI.
- Patient groups were comparable in age, gender distribution, and prevalence of comorbidities like diabetes.
- No significant differences were observed in 30-day mortality (1.1% vs. 0.5%) or 30-day MACE (2.2% in both groups).
Conclusions:
- Contemporary data from a large cohort indicate no association between coronary dominance and clinical outcomes in PDA PCI.
- Left-sided vs. right-sided PDA PCI procedures demonstrated comparable safety and efficacy profiles.
- Coronary dominance does not appear to be a significant factor influencing outcomes for PDA interventions.
Introduction:
Percutaneous coronary intervention (PCI) is an important treatment for coronary artery disease, and coronary dominance may influence procedural risk. PCI to a left-sided posterior descending artery (L-PDA) occurs in the setting of left-dominant coronary anatomy and may involve greater anatomical complexity and a larger myocardial territory at risk than PCI to a right-sided PDA (R-PDA). We performed a retrospective analysis of a statewide registry to compare the characteristics and outcomes of R-PDA and L-PDA PCI.
Methods:
The Victorian Cardiac Outcomes Registry is a state-wide quality registry with all PCI capable centres in Victoria, Australia contributing. We undertook a retrospective analysis of patients undergoing PCI for L-PDA and R-PDA lesions between 2013 and 2022.
Results:
2,880 patients were included over the 10-year study period, with 2,282 (79.2%) undergoing R-PDA PCI and 598 (20.8%) undergoing L-PDA PCI. Patient characteristics between groups were of similar age (66.3 years in both groups), gender (17.9% vs. 14.5%; p = 0.06) and had comparable rates of comorbidities including diabetes (25.8% vs. 24.9%; p = 0.66). There was no significant difference between groups with respect to 30-day mortality (1.1% vs. 0.5%; p = 0.21). 30-day MACE was also comparable (2.2% both groups; p = 0.93).
Conclusions:
Data from a large contemporary cohort did not find any association between coronary dominance and clinical outcomes when undertaking PDA PCI.
