Coronary artery dominance and the risk of adverse clinical events following percutaneous coronary intervention: insights from the prospective, randomised TWENTE trial

Ming Kai Lam, Kenneth Tandjung, Hanim Sen, Mounir W.Z. Basalus, G. van Houwelingen, Martin G. Stoel, Johannes Louwerenburg, Gerard C.M. Linssen, Salah A.M. Said, Mark B. Nienhuis, Frits H.A.F. de Man, Job van der Palen, Clemens von Birgelen

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Abstract

Aims: To investigate the prognostic value of coronary dominance for various adverse clinical events following the implantation of drug-eluting stents.

Methods and results: We assessed two-year follow-up data of 1,387 patients from the randomised TWENTE trial. Based on the origin of the posterior descending coronary artery, coronary circulation was categorised into left and non-left dominance (i.e., right and balanced). Target vessel-related myocardial infarction (MI) was defined according to the updated Academic Research Consortium (ARC) definition (2x upper reference limit of creatine kinase [CK], confirmed by CK-MB elevation), and periprocedural MI (PMI) as MI ≤48 hours following PCI. One hundred and thirty-six patients (9.8%) had left and 1,251 (90.2%) non-left dominance. Target lesions were more frequently located in dominant arteries (p<0.005). Left dominance was associated with more severe calcifications (p=0.006) and more bifurcation lesions (p=0.031). Non-left dominance tended to be less frequent in men (p=0.09). Left coronary dominance was associated with more target vessel-related MI (14 [10.3%] vs. 62 [5.0%], p=0.009). Left dominance independently predicted PMI (adjusted HR 2.19, 95% CI: 1.15-4.15, p=0.017), while no difference in other clinical endpoints was observed between dominance groups.

Conclusions: In the population of the TWENTE trial, we observed a higher incidence of periprocedural myocardial infarction in patients who had left coronary dominance. - See more at: http://www.pcronline.com/eurointervention/ahead_of_print/201402-11/#sthash.p3Zkzx7X.dpf

Original languageEnglish
Article number32
Pages (from-to)180-187
JournalEuroIntervention
Volume11
Issue number2
DOIs
Publication statusPublished - 28 Feb 2015

Keywords

  • METIS-304660
  • IR-91535
  • Percutaneous Coronary Intervention (PCI)
  • Periprocedural myocardial infarction
  • TWENTE trial
  • Cronary dominance

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