Abstract 11267: Impact of Coronary Dominance on In-Hospital Outcomes After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome
Objective: This study evaluated the manner in which coronary dominance affects in-hospital outcomes of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).
Background: Previous studies have shown that left dominant coronary systems are associated with worse prognoses in patients with coronary artery disease.
Methods: Data were analyzed from 4873 ACS patients undergoing PCI between September 2008 and August 2012 at 14 hospitals participating in the Japanese Cardiovascular Database Registry. The patients were grouped based on diagnostic coronary angiograms performed prior to PCI; those with right- or co-dominant anatomy (RD group) and those with left-dominant anatomy (LD group).
Results: The average patient age was 67.6 ± 11.8 years and both patient groups had similar age, coronary risk factors, comorbidities and prior histories. The numbers of patients presenting with symptoms of heart failure, cardiogenic shock, or cardiopulmonary arrest were significantly different in both groups (heart failure; 650 RD group patients [14.7%] vs. 87 LD group patients [18.8%]; P = 0.025, cardiogenic shock; 322 RD group patients [7.3%] vs. 48 LD group patients [10.3%]; P = 0.021, cardiopulmonary arrest; 197 RD group patients [4.5%] vs. 36 LD group patients [7.8%]; P = 0.003). In-hospital mortality was significantly higher among LD patients (RD group 4.1% vs. LD group 7.8%; P = 0.001). Multivariate analysis of the predictors for in-hospital mortality showed that LD anatomy was the significant predictor for in-hospital mortality (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.06-2.89; P=0.030).
Conclusion: Among ACS patients who underwent PCI, LD patients had significantly worse in-hospital outcomes compared with RD patients. LD anatomy was the significant predictor for in-hospital mortality. The single arterial supply to the cardiac myocardium, characteristic of LD-affected systems, needs to be recognized as a high-risk feature.
- © 2013 by American Heart Association, Inc.