Prevalence and clinical impact of left coronary dominance in patients with aortic stenosis.

BACKGROUND AND AIM OF THE STUDY

Left coronary dominance may be more prevalent in patients with valvular aortic stenosis (AS). A cohort study was conducted to: (i) determine the prevalence of coronary left dominance in patients with AS; (ii) assess if a possible higher prevalence of left dominance is confined to patients with bicuspid aortic valve; (iii) examine if left dominance is a risk factor for the progression of AS, independent of established risk factors; and (iv) assess in-hospital clinical outcome following valve replacement according to the coronary dominance pattern.

METHODS

The prevalence of left coronary dominance was analyzed in 721 patients with severe isolated AS, and compared to a control cohort of 6,990 patients without AS. The clinical data and short-term outcome following valve replacement were assessed according to the coronary dominance pattern.

RESULTS

Left coronary dominance was significantly more prevalent in patients with AS compared to those without AS (13.7% versus 10.2%, p = 0.003), and a pattern of right coronary dominance was less frequent in patients with AS (66.9% versus 71.6%, p = 0.008), irrespective of the presence of a bicuspid or tricuspid valve. Left coronary dominance was not an independent predictor of younger age at the time of valve replacement. There were no differences for in-hospital mortality and rates of myocardial infarction between coronary dominance types.

CONCLUSION

Although left coronary dominance is more prevalent in patients with AS, it is not a risk factor for disease progression, and is not associated with short-term adverse outcome following valve replacement.