Relation Between Coronary Arterial Dominance and Left Ventricular Ejection Fraction After ST-Segment Elevation Acute Myocardial Infarction in Patients Having Percutaneous Coronary Intervention

• Published in: The American journal of cardiology Vol. 114; no. 11; pp. 1646 - 1650
• Main Authors: Veltman, Caroline E., Hoogslag, Georgette E., Kharbanda, Rohit K., de Graaf, Michiel A., van Zwet, Erik W., van der Hoeven, Bas L., Delgado, Victoria, Bax, Jeroen J., Scholte, Arthur J.H.A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2014; Elsevier Limited
• Subjects: Aged; Cardiology; Cardiovascular; Cardiovascular disease; Cohort Studies; Coronary Angiography; Coronary Circulation - physiology; Coronary vessels; Coronary Vessels - diagnostic imaging; Echocardiography; Female; Fractions; Heart attacks; Humans; Kinases; Longitudinal Studies; Male; Middle Aged; Mortality; Myocardial Infarction - complications; Myocardial Infarction - therapy; Percutaneous Coronary Intervention; Recovery of Function; Software; Stroke Volume; Variance analysis; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2014.08.035

The presence of a left dominant coronary artery system is associated with worse outcome after ST-segment elevation myocardial infarction (STEMI) compared with right dominance or a balanced coronary artery system. However, the association between coronary arterial dominance and left ventricular (LV) function at follow-up after STEMI is unclear. The present study aimed at evaluating the relation between coronary arterial dominance and LV ejection fraction (LVEF) shortly after STEMI and at 12-month follow-up. A total of 741 patients with STEMI (mean age 60 ± 11 years and 77% men) were evaluated with 2-dimentional echocardiography within 48 hours of admission (baseline) and at 12-month follow-up after STEMI. Coronary arterial dominance was assessed on the angiographic images obtained during primary percutaneous coronary intervention. A right, left, and balanced dominant coronary artery system was noted in 640 (86%), 58 (8%), and 43 (6%) patients, respectively. At baseline, significant difference in LV function was observed, with slightly lower LVEF in patients with a left dominant coronary artery system (LVEF 45 ± 8% vs 48 ± 9% and 50 ± 9%, for left dominant, right dominant, and balanced coronary artery system respectively, p = 0.03). However, at 12-month follow-up no differences in LV function or volumes were observed among the different coronary arterial dominance groups. In conclusion, patients with a left dominant coronary artery system had lower LVEF early after STEMI. At 12-month follow-up, differences in LVEF were no longer present among the different coronary arterial dominance groups.