Influence of coronary vessel dominance on short- and long-term outcome in patients after ST-segment elevation myocardial infarction.

Abstract:

AIMS:Prognostic importance of coronary vessel dominance in patients with ST-elevation myocardial infarction (STEMI) remains uncertain. The aim of this study was to assess influence of coronary vessel dominance on the short- and long-term outcome after STEMI. METHODS AND RESULTS:Coronary angiographic images of consecutive patients presenting with first STEMI were retrospectively reviewed to assess coronary vessel dominance. Patients were followed after STEMI during a median period of 48 (IQR38-61) months for the occurrence of all-cause mortality and the composite of reinfarction and cardiac death. The population comprised 1131 patients of which 971 (86%) patients had a right dominant, 102 (9%) a left dominant, and 58 (5%) a balanced system. After 5 years of follow-up, the cumulative incidence of all-cause mortality was significantly higher in patients with a left dominant system, compared with a right dominant and balanced system (log-rank P = 0.013). Moreover, a left dominant system was an independent predictor for 30-day mortality (OR 2.51, 95% CI 1.11-5.67, P = 0.027) and the composite of reinfarction and cardiac death within 30-days after STEMI (OR 2.25, 95% CI 1.09-4.61, P = 0.028). In patients surviving first 30-days post-STEMI, coronary vessel dominance had no influence on long-term outcome. CONCLUSIONS:A left dominant coronary artery system is associated with a significantly increased risk of 30-day mortality and early reinfarction after STEMI. After surviving the first 30-days post-STEMI, coronary vessel dominance had no influence on long-term outcome.

journal_name

Eur Heart J

journal_title

European heart journal

authors

Veltman CE,van der Hoeven BL,Hoogslag GE,Boden H,Kharbanda RK,de Graaf MA,Delgado V,van Zwet EW,Schalij MJ,Bax JJ,Scholte AJ

doi

10.1093/eurheartj/ehu236

subject

Has Abstract

pub_date

2015-05-01 00:00:00

pages

1023-30

issue

17

eissn

0195-668X

issn

1522-9645

pii

ehu236

journal_volume

36

pub_type

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