Department of Critical Care Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Cardiology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
BMC Cardiovasc Disord. 2019 Feb 4;19(1):35. doi: 10.1186/s12872-019-1007-5.
Previous studies have found a connection between left coronary artery dominance and worse prognoses in patient with acute coronary syndrome, which remains a predominant cause of morbidity and mortality globally. The aim of this study was to investigate whether coronary dominance is associated with the incidence of acute inferior myocardial infarction (MI).
Between January 2011 and November 2014, 265 patients with acute inferior MI and 530 age-matched and sex-matched controls were recruited for a case-control study in the Second Affiliated Hospital of Xi'an Jiaotong University in Xi'an, China. All participants underwent coronary angiography. The exclusion criteria included history of coronary artery bypass graft surgery, chronic or systemic diseases (including hepatic failure, kidney failure, hypothyroidism and Grave's disease), ventricular fibrillation, and known allergy to iodinated contrast agent. Patients with left- or co-dominant anatomies were placed into the LD group and those with right-dominant anatomy were included in the RD group. The association of acute inferior MI and coronary dominant anatomy were assessed using multivariable conditional logistic regression, and to estimate the odds ratio (OR) and 95% confidence interval (95%CI).
Distributions of right dominance were significantly different between the acute inferior MI group and control group (94.0% vs. 87.9%, P = 0.018). Univariable conditional logistic regression revealed that right dominance may be a risk factor for the incident acute inferior MI (OR: 2.137; 95% CI: 1.210-3.776; P = 0.009). After adjusting for baseline systolic blood pressure, heart rate, smoking status, diabetes mellitus, hypertension, hyperlipidaemia, and family history of coronary artery disease, results of multivariate conditional logistic regression showed that right dominance was associated with the incidence of acute inferior MI (OR: 2.396; 95% CI: 1.328-4.321; P = 0.004).
Right coronary dominance may play a disadvantageous role in the incidence of acute inferior MI. However, further studies are needed to verify our findings, especially with regard to the underlying mechanisms.
先前的研究发现左冠状动脉优势与急性冠状动脉综合征患者的预后较差之间存在关联，而急性冠状动脉综合征仍是全球发病率和死亡率的主要原因。本研究旨在探讨冠状动脉优势与急性下壁心肌梗死（MI）的发生率之间是否存在关联。
本病例对照研究于 2011 年 1 月至 2014 年 11 月在西安交通大学第二附属医院进行，共纳入 265 例急性下壁 MI 患者和 530 例年龄和性别匹配的对照组患者。所有参与者均接受冠状动脉造影检查。排除标准包括冠状动脉旁路移植术史、慢性或系统性疾病（包括肝衰竭、肾衰竭、甲状腺功能减退症和格雷夫斯病）、心室颤动以及已知对碘造影剂过敏。解剖学上左优势或共优势的患者归入 LD 组，右优势解剖学的患者归入 RD 组。采用多变量条件逻辑回归评估急性下壁 MI 与冠状动脉优势解剖结构的相关性，并估算比值比（OR）及其 95%置信区间（95%CI）。
急性下壁 MI 组和对照组右优势分布差异有统计学意义（94.0%比 87.9%，P=0.018）。单变量条件逻辑回归显示，右优势可能是急性下壁 MI 的危险因素（OR：2.137；95%CI：1.210-3.776；P=0.009）。在校正了基线收缩压、心率、吸烟状况、糖尿病、高血压、高脂血症和冠心病家族史后，多变量条件逻辑回归结果显示，右优势与急性下壁 MI 的发生相关（OR：2.396；95%CI：1.328-4.321；P=0.004）。
右冠状动脉优势可能在下壁急性 MI 的发生中发挥不利作用。然而，需要进一步的研究来验证我们的发现，特别是关于潜在机制的研究。
