Association between coronary dominance and acute inferior myocardial infarction: a matched, case-control study
Association between coronary dominance and acute inferior myocardial infarction: a matched, case-control study
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DOI：
10.1186/s12889-019-6722-4
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发表时间：
2019-02-04
影响因子：
2.1
通讯作者：
Wang, Xiaochuang
中科院分区：
文献类型：
--
作者：
Wang, Li;Li, Jiamei;Wang, Xiaochuang
背景先前的研究发现左冠状动脉优势与急性冠状动脉综合征患者预后不良之间存在联系，急性冠状动脉综合征仍然是全球发病率和死亡率的主要原因。本研究的目的是探讨冠状动脉优势是否与急性下壁心肌梗死（MI）的发生率相关。方法2011年1月至2014年11月，在西安交通大学第二附属医院招募265例急性下壁心肌梗死患者和530例年龄匹配和性别匹配的对照组，进行病例对照研究。所有参与者都接受了冠状动脉造影。排除标准包括冠状动脉搭桥手术史、慢性或全系统疾病（包括肝功能衰竭、肾衰竭、甲状腺功能减退和格雷夫斯病）、心室颤动和已知对碘造影剂过敏。左或共优势解剖的患者被分为LD组，右优势解剖的患者被分为RD组。使用多变量条件logistic回归评估急性下壁心肌梗死与冠状动脉优势解剖的相关性，并估计优势比（OR）和95%可信区间（95% ci）。结果急性下壁心肌梗死组与对照组右优势度分布差异有统计学意义（94.0% vs 87.9%， P=0.018）。单变量条件logistic回归显示右侧优势可能是急性下位心肌梗死发生的危险因素（OR: 2.137; 95% CI: 1.210 ~ 3.776； P=0.009）。在对基线收缩压、心率、吸烟状况、糖尿病、高血压、高脂血症和冠状动脉疾病家族史进行校正后，多因素条件logistic回归结果显示，右优势与急性下壁心肌梗死发生率相关（OR: 2.396; 95% CI: 1.328-4.321； P=0.004）。结论右冠状动脉优势可能在急性下壁心肌梗死的发生中起不利作用，但需要进一步的研究来验证我们的发现，特别是其潜在的机制。
BackgroundPrevious studies have found a connection between left coronary artery dominance and worse prognoses in patient with acute coronary syndrome, which remains a predominant cause of morbidity and mortality globally. The aim of this study was to investigate whether coronary dominance is associated with the incidence of acute inferior myocardial infarction (MI).MethodsBetween January 2011 and November 2014, 265 patients with acute inferior MI and 530 age-matched and sex-matched controls were recruited for a case-control study in the Second Affiliated Hospital of Xi'an Jiaotong University in Xi'an, China. All participants underwent coronary angiography. The exclusion criteria included history of coronary artery bypass graft surgery, chronic or systemic diseases (including hepatic failure, kidney failure, hypothyroidism and Grave's disease), ventricular fibrillation, and known allergy to iodinated contrast agent. Patients with left- or co-dominant anatomies were placed into the LD group and those with right-dominant anatomy were included in the RD group. The association of acute inferior MI and coronary dominant anatomy were assessed using multivariable conditional logistic regression, and to estimate the odds ratio (OR) and 95% confidence interval (95%CI).ResultsDistributions of right dominance were significantly different between the acute inferior MI group and control group (94.0% vs. 87.9%, P=0.018). Univariable conditional logistic regression revealed that right dominance may be a risk factor for the incident acute inferior MI (OR: 2.137; 95% CI: 1.210-3.776; P=0.009). After adjusting for baseline systolic blood pressure, heart rate, smoking status, diabetes mellitus, hypertension, hyperlipidaemia, and family history of coronary artery disease, results of multivariate conditional logistic regression showed that right dominance was associated with the incidence of acute inferior MI (OR: 2.396; 95% CI: 1.328-4.321; P=0.004).ConclusionsRight coronary dominance may play a disadvantageous role in the incidence of acute inferior MI. However, further studies are needed to verify our findings, especially with regard to the underlying mechanisms.