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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冠状动脉优势与急性下壁心肌梗死之间的关联：一项匹配的病例对照研究
DOI：
10.1186/s12872-019-1007-5
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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
研究背景急性冠状动脉综合征（acute coronary syndrome，ACS）是全球发病率和死亡率最高的疾病之一，以往的研究发现左冠状动脉优势与ACS患者病情恶化有关。本研究的目的是调查冠状动脉优势是否与急性下壁心肌梗死（MI）的发病率相关。MethodsBetween 2011年1月至2014年11月，在中国西安市西安交通大学第二附属医院招募了265例急性下壁心肌梗死患者和530例年龄和性别匹配的对照者进行病例对照研究。所有参与者均接受了冠状动脉造影。排除标准包括冠状动脉旁路移植术史、慢性或全身性疾病（包括肝衰竭、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化造影剂过敏。左侧或共优势解剖结构的患者被纳入LD组，右侧优势解剖结构的患者被纳入RD组。结果急性下壁心肌梗死组与对照组右冠状动脉优势分布差异有统计学意义（94.0%vs.87.9%，P = 0.018）。单因素条件Logistic回归分析显示，右优势可能是急性下壁心肌梗死的危险因素（OR：2.137;95% CI：1.210-3.776;P= 0.009）。校正基线收缩压、心率、吸烟状况、糖尿病、高血压、高血脂和冠状动脉疾病家族史后，多变量条件Logistic回归结果显示右优势与急性下壁心肌梗死的发生率相关（OR：2.396;95% CI：1.328-4.321;P= 0.004）。结论右冠状动脉优势可能对急性下壁心肌梗死的发生起不利作用。然而，需要进一步的研究来验证我们的发现，特别是关于潜在的机制。
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.