TY - JOUR
T1 - Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography
T2 - Results from the CONFIRM (COronary CTAngiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) registry
AU - Gebhard, Catherine
AU - Fuchs, Tobias A.
AU - Stehli, Julia
AU - Gransar, Heidi
AU - Berman, Daniel S.
AU - Budoff, Matthew J.
AU - Achenbach, Stephan
AU - Al-Mallah, Mouaz
AU - Andreini, Daniele
AU - Cademartiri, Filippo
AU - Callister, Tracy Q.
AU - Chang, Hyuk Jae
AU - Chinnaiyan, Kavitha M.
AU - Chow, Benjamin J.W.
AU - Cury, Ricardo C.
AU - Delago, Augustin
AU - Gomez, Millie J.
AU - Hadamitzky, Martin
AU - Hausleiter, Joerg
AU - Hindoyan, Niree
AU - Feuchtner, Gudrun
AU - Kim, Yong Jin
AU - Leipsic, Jonathon
AU - Lin, Fay Y.
AU - Maffei, Erica
AU - Pontone, Gianluca
AU - Raff, Gilbert
AU - Shaw, Leslee J.
AU - Villines, Todd C.
AU - Dunning, Allison M.
AU - Min, James K.
AU - Kaufmann, Philipp A.
N1 - Publisher Copyright:
© The Author 2015.
PY - 2015/8
Y1 - 2015/8
N2 - Aims: 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. Methods and results: 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. Conclusion: In our study population, survival after 5 years of follow-up did not differ significantly between patientswith 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.
AB - Aims: 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. Methods and results: 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. Conclusion: In our study population, survival after 5 years of follow-up did not differ significantly between patientswith 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.
KW - Coronary computed tomographic angiography
KW - Coronary dominance
KW - Predictive value
UR - http://www.scopus.com/inward/record.url?scp=84942116120&partnerID=8YFLogxK
U2 - 10.1093/ehjci/jeu314
DO - 10.1093/ehjci/jeu314
M3 - Article
C2 - 25744341
AN - SCOPUS:84942116120
SN - 2047-2404
VL - 16
SP - 853
EP - 862
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
IS - 8
ER -