Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography: results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry

Gebhard C, Fuchs TA, Stehli J, Gransar H, Berman DS, Budoff MJ, Achenbach S, Al-Mallah M, Andreini D, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan KM, Chow BJW, Cury RC, Delago A, Gomez MJ, Hadamitzky M, Hausleiter J, Hindoyan N, Feuchtner G, Kim YJ, Leipsic J, Lin FY, Maffei E, Pontone G, Raff G, Shaw LJ, Villines TC, Dunning AM, Min JK, Kaufmann PA (2015)

Publication Type: Journal article

Publication year: 2015

Journal

Book Volume: 16

Pages Range: 853-62

Journal Issue: 8

DOI: 10.1093/ehjci/jeu314

Abstract

Coronary computed tomographic angiography (CCTA) has become an important tool for non-invasive diagnosis of coronary artery disease (CAD). Coronary dominance can be assessed by CCTA; however, the predictive value of coronary dominance is controversially discussed. The aim of this study was to evaluate the prevalence and prognosis of coronary dominance in a large prospective, international multicentre cohort of patients undergoing CCTA.The study population consisted of 6382 patients with or without CAD (47% females, 53% males, mean age 56.9 ± 12.3 years) who underwent CCTA and were followed over a period of 60 months. Right or left coronary dominance was determined. Right dominance was present in 91% (n = 5817) and left in 9% (n = 565) of the study population. At the end of follow-up, outcome in patients with obstructive CAD (>50% luminal stenosis) and right dominance was similar compared with patients with left dominance [hazard ratio (HR) 0.46, 95% CI 0.16-1.32, P = 0.15]. Furthermore, no differences were observed for the type of coronary dominance in patients with non-obstructive CAD (HR 0.95, 95% CI 0.41-2.21, P = 0.8962) or normal coronary arteries (HR 1.04, 95% CI 0.68-1.59, P = 0.9). Subgroup analysis in patients with left main disease revealed an elevated hazard of the combined endpoint for left dominance (HR 6.45, 95% CI 1.66-25.0, P = 0.007), but not for right dominance.In our study population, survival after 5 years of follow-up did not differ significantly between patients with left or right coronary dominance. Thus, assessment of coronary vessel dominance by CCTA may not enhance risk stratification in patients with normal coronary arteries or obstructive CAD, but may add prognostic information for specific subpopulations.

Authors with CRIS profile

Involved external institutions

Universitätsspital Zürich (USZ) Switzerland (CH) New York Presbyterian Hospital United States (USA) (US) Emory University United States (USA) (US) Beaumont Hospital Ireland (IE) Università degli studi di Milano Italy (IT) Casa di Cura Giovanni XXIII Italy (IT) University of British Columbia Canada (CA) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) Medizinische Universität Innsbruck Austria (AT) Ludwig-Maximilians-Universität (LMU) Germany (DE) Deutsches Herzzentrum München Germany (DE) Capitol Cardiology Associates United States (USA) (US) Baptist Health South Florida United States (USA) (US) University of Ottawa Canada (CA) Yonsei University Health System (YUHS) Korea, Republic of (KR) Tennessee Heart & Vascular United States (USA) (US) Duke University Medical Center United States (USA) (US) Wayne State University (WSU) United States (USA) (US) Harbor–UCLA Medical Center United States (USA) (US) Cedars-Sinai Medical Center United States (USA) (US)

How to cite

APA:

Gebhard, C., Fuchs, T.A., Stehli, J., Gransar, H., Berman, D.S., Budoff, M.J.,... Kaufmann, P.A. (2015). Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography: results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry. European Heart Journal - Cardiovascular Imaging, 16(8), 853-62. https://doi.org/10.1093/ehjci/jeu314

MLA:

Gebhard, Catherine, et al. "Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography: results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry." European Heart Journal - Cardiovascular Imaging 16.8 (2015): 853-62.

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