Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography: Results from the CONFIRM (COronary CTAngiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) registry

Catherine Gebhard, Tobias A. Fuchs, Julia Stehli, Heidi Gransar, Daniel S. Berman, Matthew J. Budoff, Stephan Achenbach, Mouaz Al-Mallah, Daniele Andreini, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Kavitha M. Chinnaiyan, Benjamin J.W. Chow, Ricardo C. Cury, Augustin Delago, Millie J. Gomez, Martin Hadamitzky, Joerg Hausleiter, Niree HindoyanGudrun Feuchtner, Yong Jin Kim, Jonathon Leipsic, Fay Y. Lin, Erica Maffei, Gianluca Pontone, Gilbert Raff, Leslee J. Shaw, Todd C. Villines, Allison M. Dunning, James K. Min, Philipp A. Kaufmann

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)853-862
Number of pages10
JournalEuropean heart journal cardiovascular Imaging
Volume16
Issue number8
DOIs
Publication statusPublished - 2015

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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