Prognostic value of coronary vessel dominance in relation to significant coronary artery disease determined with non-invasive computed tomography coronary angiography
Prognostic value of coronary vessel dominance in relation to significant coronary artery disease determined with non-invasive computed tomography coronary angiography
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DOI：
10.1093/eurheartj/ehs034
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发表时间：
2012-06-01
影响因子：
39.3
通讯作者：
van der Wall, Ernst E.
中科院分区：
文献类型：
--
作者：
Veltman, Caroline E.;de Graaf, Fleur R.;van der Wall, Ernst E.
关于冠状动脉优势与预后之间的关系，信息有限。因此，本研究的目的是确定冠状动脉血管优势的预后价值与显着的冠状动脉疾病（CAD）的患者提到的计算机断层扫描冠状动脉造影（CTA）。研究人群包括1425例（869名男性，57 - 12岁）提到CTA。为了评价血管优势和显著CAD对CTA结果的影响，对患者进行了中位24个月的非致死性心肌梗死和全因死亡率随访。左侧优势系统的存在被确定为非致死性心肌梗死和全因死亡率的重要预测因子（HR：3.20; 95 CI：1.676.13，P 0.001），并且相对于基线风险因素和CTA上的CAD严重程度具有增量值。此外，在CTA显示有显著CAD的患者亚组中，左侧优势系统患者的结局比右侧优势系统患者更差（累积事件发生率：右侧和左侧优势冠状动脉系统在3年随访时分别为9.5和35，对数秩P 0.001）。左优势系统的存在被确定为非致死性心肌梗死和全因死亡率的独立预测因子，尤其是在CTA显示有显著CAD的患者中。因此，在CTA上评估冠状动脉血管优势可能会进一步增强CTA上评估严重CAD之外的风险分层。
Limited information is available regarding the relationship between coronary vessel dominance and prognosis. Therefore, the purpose of this study was to determine the prognostic value of coronary vessel dominance in relation to significant coronary artery disease (CAD) in patients referred for computed tomography coronary angiography (CTA).The study population consisted of 1425 patients (869 men, 57 12 years) referred for CTA. To evaluate the impact of vessel dominance and significant CAD on CTA on outcome, patients were followed during a median period of 24 months for the occurrence of non-fatal myocardial infarction and all-cause mortality. The presence of a left dominant system was identified as a significant predictor for non-fatal myocardial infarction and all-cause mortality (HR: 3.20; 95 CI: 1.676.13, P 0.001) and had incremental value over baseline risk factors and severity of CAD on CTA. In addition, in the subgroup of patients with significant CAD on CTA, patients with a left dominant system had a worse outcome compared with patients with a right dominant system (cumulative event rates: 9.5 and 35 at 3-year follow-up for a right and left dominant coronary artery system, respectively, log-rank P 0.001).The presence of a left dominant system was identified as an independent predictor of non-fatal myocardial infarction and all-cause mortality, especially in patients with significant CAD on CTA. Therefore, the assessment of coronary vessel dominance on CTA may further enhance risk stratification beyond the assessment of significant CAD on CTA.