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Caroline E. Veltman, Fleur R. de Graaf, Joanne D. Schuijf, Jacob M. van Werkhoven, J. Wouter Jukema, Philipp A. Kaufmann, Aju P. Pazhenkottil, Lucia J. Kroft, Eric Boersma, Jeroen J. Bax, Martin J. Schalij, Ernst E. van der Wall, Prognostic value of coronary vessel dominance in relation to significant coronary artery disease determined with non-invasive computed tomography coronary angiography, European Heart Journal, Volume 33, Issue 11, June 2012, Pages 1367–1377, https://doi.org/10.1093/eurheartj/ehs034
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Abstract
Limited information is available regarding the relationship between coronary vessel dominance and prognosis. Therefore, the purpose of this study was to determine the prognostic value of coronary vessel dominance in relation to significant coronary artery disease (CAD) in patients referred for computed tomography coronary angiography (CTA).
The study population consisted of 1425 patients (869 men, 57 ± 12 years) referred for CTA. To evaluate the impact of vessel dominance and significant CAD on CTA on outcome, patients were followed during a median period of 24 months for the occurrence of non-fatal myocardial infarction and all-cause mortality. The presence of a left dominant system was identified as a significant predictor for non-fatal myocardial infarction and all-cause mortality (HR: 3.20; 95% CI: 1.67–6.13, P < 0.001) and had incremental value over baseline risk factors and severity of CAD on CTA. In addition, in the subgroup of patients with significant CAD on CTA, patients with a left dominant system had a worse outcome compared with patients with a right dominant system (cumulative event rates: 9.5% and 35% at 3-year follow-up for a right and left dominant coronary artery system, respectively, log-rank P < 0.001).
The presence of a left dominant system was identified as an independent predictor of non-fatal myocardial infarction and all-cause mortality, especially in patients with significant CAD on CTA. Therefore, the assessment of coronary vessel dominance on CTA may further enhance risk stratification beyond the assessment of significant CAD on CTA.
Comments
Left coronary dominance and clinical outcome
Reuben Ilia MD , ,Arik Wollak MD and Jean Marc Weinstein MD Cardiology Department , Soroka Medical Center, Beer Sheva , Israel
Re: "Prognostic value of coronary vessel dominance in relation to significant coronary artery disease determined with non-invasive computed tomography coronary angiography."Veltman CE, de Graaf FR, Schuijf JD, van Werkhoven JM, Jukema JW, Kaufmann PA, Pazhenkottil AP, Kroft LJ, Boersma E, Bax JJ, Schalij MJ, van der Wall EE.Eur Heart J. 2012 Jun;33(11):1367- 77. Epub 2012 Mar 4. To the Editor,
We read with interest the article by C.E. Veltman et al (1). They studied a population of patients referred for CTA. We would like to add some important comments based on our previous observations. Firstly, acute occlusion of the proximal portion of a dominant left circumflex coronary artery during acute myocardial infarction is related with haemodynamic instability and a poor outcome (2). In addition, in general, the left circumflex coronary artery has a relative paucity of collaterals as we have described (3). As a result, this may be a contributing factor to the poor outcome of patients with diseased dominant left circumflex arteries.
1.Veltman CE, de Graaf FR, Schuijf JD, van Werkhoven JM, Jukema JW, Kaufmann PA, Pazhenkottil AP, Kroft LJ, Boersma E, Bax JJ, Schalij MJ, van der Wall EE.Prognostic value of coronary vessel dominance in relation to significant coronary artery disease determined with non-invasive computed tomography coronary angiography.Eur Heart J. 2012 Jun; 33(11):1367-77. Epub 2012 Mar 4.
2.Ilia R, Cafri C, Weinstein JM, Gueron M. Acute myocardial infarction due to occlusion of the dominant left circumflex artery proximally. Am J Cardiol. 2003 Jul 1;92(1):54-5.
3.Ilia R, Carmel S, Cafri C, Gueron M.Coronary collaterals in patients with normal and impaired left ventricular systolic function. Int J Cardiol. 1998 Jan 31; 63 (2):151-3.
Conflict of Interest:
None declared