title: 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.
abstract: 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.
  
  
  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.
authors.affiliation: Cardiology Division, Queens Medical Center, Honolulu, HI 96813, USA. nparikh@queens.org
authors.forename: Nisha I
authors.initials: NI
authors.lastname: Parikh
authors.forename: Emily F
authors.initials: EF
authors.lastname: Honeycutt
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.forename: Megan
authors.initials: M
authors.lastname: Neely
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Rosenthal
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Carrozza
authors.forename: Kalon K L
authors.initials: KK
authors.lastname: Ho
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D003326:Coronary Circulation; D016002:Discriminant Analysis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States