title: Impact of coronary dominance on in-hospital outcomes after percutaneous coronary intervention in patients with acute coronary syndrome.
abstract: OBJECTIVE
  This study evaluated the manner in which coronary dominance affects in-hospital outcomes of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Previous studies have shown that left dominant coronary anatomies are associated with worse prognoses in patients with coronary artery disease.
  
  
  METHODS
  Data were analyzed from 4873 ACS patients undergoing PCI between September 2008 and April 2013 at 14 hospitals participating in the Japanese Cardiovascular Database Registry. The patients were grouped based on diagnostic coronary angiograms performed prior to PCI; those with right- or co-dominant anatomy (RD group) and those with left-dominant anatomy (LD group).
  
  
  RESULTS
  The average patient age was 67.6±11.8 years and both patient groups had similar ages, coronary risk factors, comorbidities, and prior histories. The numbers of patients presenting with symptoms of heart failure, cardiogenic shock, or cardiopulmonary arrest were significantly higher in the LD group than in the RD group (heart failure: 650 RD patients [14.7%] vs. 87 LD patients [18.8%], P = 0.025; cardiogenic shock: 322 RD patients [7.3%] vs. 48 LD patients [10.3%], P = 0.021; and cardiopulmonary arrest: 197 RD patients [4.5%] vs. 36 LD patients [7.8%], P = 0.003). In-hospital mortality was significantly higher among LD patients than among RD patients (182 RD patients [4.1%] vs. 36 LD patients [7.8%], P = 0.001). Multivariate logistic regression analysis revealed that LD anatomy was an independent predictor for in-hospital mortality (odds ratio, 1.75; 95% confidence interval, 1.06-2.89; P = 0.030).
  
  
  CONCLUSIONS
  Among ACS patients who underwent PCI, LD patients had significantly worse in-hospital outcomes compared with RD patients, and LD anatomy was an independent predictor of in-hospital mortality.
authors.affiliation: Department of Cardiology, Ashikaga Red Cross Hospital, Tochigi, Japan. kuno-toshiki@hotmail.co.jp
authors.forename: Toshiki
authors.initials: T
authors.lastname: Kuno
authors.forename: Yohei
authors.initials: Y
authors.lastname: Numasawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Takahashi
authors.forename: Koichiro
authors.initials: K
authors.lastname: Sueyoshi
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ohki
authors.forename: Koji
authors.initials: K
authors.lastname: Negishi
authors.forename: Akio
authors.initials: A
authors.lastname: Kawamura
authors.forename: Shun
authors.initials: S
authors.lastname: Kohsaka
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D054058:Acute Coronary Syndrome / Q000503:physiopathology / Q000601:surgery*; D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D016896:Treatment Outcome