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Left and codominant coronary artery circulations are associated with higher in-hospital mortality among patients undergoing percutaneous coronary intervention for acute coronary syndromes: report From the National Cardiovascular Database Cath Percutaneous Coronary Intervention (CathPCI) Registry.

Publication ,  Journal Article
Parikh, NI; Honeycutt, EF; Roe, MT; Neely, M; Rosenthal, EJ; Mittleman, MA; Carrozza, JP; Ho, KKL
Published in: Circ Cardiovasc Qual Outcomes
November 2012

BACKGROUND: Left or codominant coronary arterial circulation may represent less well-balanced myocardial perfusion and thus confer worse prognosis in acute coronary syndrome, especially for culprit lesions arising from the left coronary artery. METHODS AND RESULTS: We related left and codominance, relative to right dominance, with in-hospital mortality in 207 926 percutaneous coronary interventions (PCI) for acute coronary syndromes from July 1, 2009 through June 30, 2010 in the National Cardiovascular Data Registry Cath Percutaneous Coronary Intervention (CathPCI) Registry database version 4. Generalized estimating equations and logistic regression analyses were used in unadjusted and multivariable adjusted models. Models were adjusted using the validated National Cardiovascular Data Registry mortality risk model. We performed subgroup analyses and formally tested for effect modification by the epicardial coronary artery containing the culprit lesion. Left coronary dominance was associated with higher in-hospital mortality in unadjusted (odds ratio=1.29, 95% confidence interval [CI], 1.17-1.42) and adjusted models (1.19, 95% CI, 1.06-1.34). Codominance was associated with worsened mortality only in adjusted models (odds ratio=1.16, 95% CI, 1.01-1.34). Addition of coronary dominance to the National Cardiovascular Data Registry risk model did not materially change model discrimination or calibration. The odds of death for left versus right dominance among those with left circumflex or left main culprit lesions was 1.25 (95% CI, 1.02-1.53), for right coronary artery lesions was 1.19 (95% CI, 0.83-1.71), and for left anterior descending artery lesions was 1.09 (95% CI, 0.93-1.28). There was no statistical evidence for effect modification by culprit lesion vessel (P=0.8). CONCLUSIONS: Left and codominance are associated with modestly increased post-percutaneous coronary intervention in-hospital mortality in patients with acute coronary syndrome. Confirmation of these findings with angiographic core laboratory verification of coronary dominance and longer term follow-up will be desirable.

Duke Scholars

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

November 2012

Volume

5

Issue

6

Start / End Page

775 / 782

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Registries
  • Percutaneous Coronary Intervention
  • Odds Ratio
  • Multivariate Analysis
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
MLA
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Parikh, N. I., Honeycutt, E. F., Roe, M. T., Neely, M., Rosenthal, E. J., Mittleman, M. A., … Ho, K. K. L. (2012). Left and codominant coronary artery circulations are associated with higher in-hospital mortality among patients undergoing percutaneous coronary intervention for acute coronary syndromes: report From the National Cardiovascular Database Cath Percutaneous Coronary Intervention (CathPCI) Registry. Circ Cardiovasc Qual Outcomes, 5(6), 775–782. https://doi.org/10.1161/CIRCOUTCOMES.111.964593
Parikh, Nisha I., Emily F. Honeycutt, Matthew T. Roe, Megan Neely, Eric J. Rosenthal, Murray A. Mittleman, Joseph P. Carrozza, and Kalon K. L. Ho. “Left and codominant coronary artery circulations are associated with higher in-hospital mortality among patients undergoing percutaneous coronary intervention for acute coronary syndromes: report From the National Cardiovascular Database Cath Percutaneous Coronary Intervention (CathPCI) Registry.Circ Cardiovasc Qual Outcomes 5, no. 6 (November 2012): 775–82. https://doi.org/10.1161/CIRCOUTCOMES.111.964593.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

November 2012

Volume

5

Issue

6

Start / End Page

775 / 782

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Registries
  • Percutaneous Coronary Intervention
  • Odds Ratio
  • Multivariate Analysis
  • Middle Aged