Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands The Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
Eur Heart J. 2015 May 1;36(17):1023-30. doi: 10.1093/eurheartj/ehu236. Epub 2014 Jun 13.
Prognostic importance of coronary vessel dominance in patients with ST-elevation myocardial infarction (STEMI) remains uncertain. The aim of this study was to assess influence of coronary vessel dominance on the short- and long-term outcome after STEMI.
Coronary angiographic images of consecutive patients presenting with first STEMI were retrospectively reviewed to assess coronary vessel dominance. Patients were followed after STEMI during a median period of 48 (IQR38-61) months for the occurrence of all-cause mortality and the composite of reinfarction and cardiac death. The population comprised 1131 patients of which 971 (86%) patients had a right dominant, 102 (9%) a left dominant, and 58 (5%) a balanced system. After 5 years of follow-up, the cumulative incidence of all-cause mortality was significantly higher in patients with a left dominant system, compared with a right dominant and balanced system (log-rank P = 0.013). Moreover, a left dominant system was an independent predictor for 30-day mortality (OR 2.51, 95% CI 1.11-5.67, P = 0.027) and the composite of reinfarction and cardiac death within 30-days after STEMI (OR 2.25, 95% CI 1.09-4.61, P = 0.028). In patients surviving first 30-days post-STEMI, coronary vessel dominance had no influence on long-term outcome.
A left dominant coronary artery system is associated with a significantly increased risk of 30-day mortality and early reinfarction after STEMI. After surviving the first 30-days post-STEMI, coronary vessel dominance had no influence on long-term outcome.
ST 段抬高型心肌梗死（STEMI）患者的冠状动脉优势程度对预后的重要性尚不确定。本研究旨在评估冠状动脉优势程度对 STEMI 后短期和长期结局的影响。
回顾性分析连续就诊的首次 STEMI 患者的冠状动脉造影图像，以评估冠状动脉优势程度。STEMI 后中位随访 48（IQR38-61）个月，评估全因死亡率和再梗死与心脏性死亡的复合终点。该人群共纳入 1131 例患者，其中 971 例（86%）为右优势型，102 例（9%）为左优势型，58 例（5%）为均衡型。5 年随访期间，左优势型患者的全因死亡率明显高于右优势型和均衡型（log-rank P=0.013）。此外，左优势型是 30 天死亡率的独立预测因素（OR 2.51，95%CI 1.11-5.67，P=0.027）和 STEMI 后 30 天内再梗死和心脏性死亡的复合终点（OR 2.25，95%CI 1.09-4.61，P=0.028）。在 STEMI 后存活 30 天的患者中，冠状动脉优势程度对长期结局无影响。
左优势型冠状动脉系统与 STEMI 后 30 天内死亡率和早期再梗死的风险显著增加相关。在 STEMI 后存活 30 天内，冠状动脉优势程度对长期结局无影响。
