Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography: results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry

• Type of Material: Article
• Authors: Catherine Gebhard, University Hospital Zurich; Tobias A. Fuchs, University Hospital Zurich; Julia Stehli, University Hospital Zurich; Heidi Gransar, Cedars-Sinai Medical Center; Daniel S. Berman, Cedars-Sinai Medical Center; Matthew J. Budoff, Harbor UCLA Medical Center; Stephan Achenbach, University of Erlangen; Mouaz Al-Mallah, Wayne State University; Daniele Andreini, University of Milan; Filippo Cademartiri, Giovanni XXIII Hospital; Tracy Q. Callister, Tennessee Heart and Vascular Institute; Hyuk-Jae Chang, Severance Cardiovascular Hospital; Kavitha M. Chinnaiyan, William Beaumont Hospital; Benjamin J. W. Chow, University of Ottawa; Ricardo C. Cury, Baptist Cardiac and Vascular Institute; Augustin Delago, Capitol Cardiology Associates; Millie J. Gomez, New York Presbyterian Hospital; Martin Hadamitzky, Deutsches Herzzentrum München; Joerg Hausleiter, University of Munich; Niree Hindoyan, New York Presbyterian Hospital; Gudrun Feuchtner, Medical University of Innsbruck; Yong-Jin Kim, Seoul National University Hospital; Jonathan Leipsic, University of British Columbia; Fay Y. Lin, New York Presbyterian Hospital; Erica Maffei, Giovanni XXIII Hospital; Gianluca Pontone, University of Milan; Gilbert Raff, William Beaumont Hospital; Leslee Shaw, Emory University; Todd C. Villines, Walter Reed National Medical Center; Allison M. Dunning, Duke Clinical Research Institute; James K. Min, New York Presbyterian Hospital; Philipp A. Kaufmann, University Hospital Zurich
• Language: English
• Date: 2015-08-01
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option B - CC-BY
• Publication Version: Final Published Version
• Copyright Statement: © The Author 2015.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ehjci/jeu314
• Title of Journal or Parent Work: EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging
• ISSN: 2047-2404
• Volume: 16
• Issue: 8
• Start Page: 853
• End Page: 862
• Grant/Funding Information: B.J.W.C. has received research support from GE Healthcare; Pfizer, Inc., New York, NY, USA and AstraZeneca, Wilmington, DE, USA, and also has received educational support from TeraRecon, Foster City, CA, USA. J.H. has received research grant support from Siemens Healthcare. P.A.K. has received research support from GE Healthcare and grant support from the Swiss National Science Foundation, Bern, Switzerland. E.M. has received grant support from GE Healthcare and is a consultant for Servier, Neuilly-sur-Seine, France.; T.C.V. has received speaker's honoraria from Boehringer-Ingelheim, Ingelheim, Germany. S.A. has received grant support from Siemens Healthcare, Erlangen, Germany, and Bayer Schering Pharma AG, Berlin, Germany, and has served as a consultant for Servier.; The views expressed here are those of the investigators only and are not to be construed as those of the US Department of the Army or Department of Defense.; G.R. has received grant support from Siemens Healthcare, Blue Cross Blue Shield Blue Care Michigan, and Bayer Pharma AG. J.K.M. has received speaker's honoraria and research support from and serves on the medical advisory board of GE Healthcare.; T.Q.C. is on the speaker's bureau of GE Healthcare. K.C. has received grant support from Bayer Pharma AG, Berlin, Germany, and Blue Cross Blue Shield Blue Care Michigan.; Funding to pay the Open Access publication charges for this article was provided by the Department of Nuclear Medicine, University Hospital Zurich and University of Zurich, Switzerland.; C.G. has received grant support from Novartis, Switzerland, and the Swiss National Science Foundation.; M.J.B. has received speaker's honoraria from GE Healthcare, Milwaukee, WI, USA. F.C. has received grant support from GE Healthcare, has served on the Speakers' Bureau of Bracco and as a consultant for Servier, and speaker's honoraria from Bracco Diagnostics, Milan, Italy.
• Keywords: LENGTH; Coronary dominance; ARTERY-DISEASE; METAANALYSIS; PREVALENCE; DIAGNOSTIC PERFORMANCE; Predictive value; Cardiac & Cardiovascular Systems; MORTALITY; Science & Technology; Life Sciences & Biomedicine; Cardiovascular System & Cardiology; HEART; AGE; Coronary computed tomographic angiography
• Research Categories: Health Sciences, Radiology; Engineering, Biomedical

Abstract

Aims: Coronary computed tomographic angiography (CCTA) has become an important tool for non-invasive diagnosis of coronary artery disease (CAD). Coronary dominance can be assessed by CCTA; however, the predictive value of coronary dominance is controversially discussed. The aim of this study was to evaluate the prevalence and prognosis of coronary dominance in a large prospective, international multicentre cohort of patients undergoing CCTA. Methods and results: The study population consisted of 6382 patients with or without CAD (47% females, 53% males, mean age 56.9±12.3 years) who underwent CCTA and were followed over a period of 60 months. Right or left coronary dominance was determined. Right dominance was present in 91% (n = 5817) and left in 9% (n = 565) of the study population. At the end of follow-up, outcome in patients with obstructive CAD (>50% luminal stenosis) and right dominance was similar compared with patients with left dominance [hazard ratio (HR) 0.46, 95% CI 0.16-1.32, P = 0.15]. Furthermore, no differences were observed for the type of coronary dominance in patients with non-obstructive CAD(HR 0.95, 95% CI 0.41-2.21, P = 0.8962) or normal coronary arteries (HR 1.04, 95% CI 0.68-1.59, P = 0.9). Subgroup analysis in patients with left main disease revealed an elevated hazard of the combined endpoint for left dominance (HR 6.45, 95% CI 1.66-25.0, P = 0.007), but not for right dominance. Conclusion: In our study population, survival after 5 years of follow-up did not differ significantly between patientswith left or right coronary dominance. Thus, assessment of coronary vessel dominance by CCTA may not enhance risk stratification in patients with normal coronary arteries or obstructive CAD, but may add prognostic information for specific subpopulations.