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Author Notes:

Corresponding author. Tel: +41 44 255 41 96; Fax: +41 44 255 44 28. E-mail: pak@usz.ch

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Research Funding:

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.

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.

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.

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.

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.

C.G. has received grant support from Novartis, Switzerland, and the Swiss National Science Foundation.

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.

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.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Cardiovascular System & Cardiology
  • Coronary dominance
  • Coronary computed tomographic angiography
  • Predictive value
  • ARTERY-DISEASE
  • DIAGNOSTIC PERFORMANCE
  • PREVALENCE
  • METAANALYSIS
  • MORTALITY
  • LENGTH
  • HEART
  • AGE

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

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Journal Title:

EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging

Volume:

Volume 16, Number 8

Publisher:

, Pages 853-862

Type of Work:

Article | Final Publisher PDF

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.

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© The Author 2015.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/).

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