Effect of coronary dominancy on clinical outcomes of patients with acute anterior myocardial infarction that were underoing primary angioplasty

Abstract

There is little study about the impact of coronary artery dominancy in patients with acute anterior STEMI treated with primary PCI as a distinct group. This study evaluated the association of coronary dominance with in-hospital and long-term outcomes of patients with acute anterior STEMI treated with PPCI.

Methods: All patients with acute anterior STEMI treated with primary PCI between April 2014 and March 2019 in Madani Heart center in northwest or Iran enrolled in present study. The patients were grouped based on data of coronary angiograms performed at the time of PPCI; those with right- or co-dominant anatomy and those with left-dominant anatomy. With using statistical methods, the independent effect of dominancy on mortality was checked out.

Results: A total of 814 patients with acute anterior STEMI (mean age 60.12 ±11.99 years and 80.2% men) were evaluated in present study. A right, left, and co- dominant coronary artery system was noted in 624 (76.66%),124 (15.23%), and 66 (8.11%) patients, respectively. Patients with left dominancy had lower hemoglobin level, higher creatinine level and more admission with Killip class >2. In-hospital mortality was higher among left dominant patients than two other groups. Also, pulmonary edema, cardiogenic shock and biomarker rising were more seen in patients with left dominancy. On the other hand, ST-segment resolution >50% was less seen in these patients. In multivariant analysis, the only independent predictor of in-hospital mortality was Killip class >2. There was a trend toward increased in-hospital mortality with left dominancy as an independent risk factor .(Pvalue =0.08)