title: Coronary artery dominance and the risk of adverse clinical events following percutaneous coronary intervention: insights from the prospective, randomised TWENTE trial.
abstract: OBJECTIVE
  To investigate the prognostic value of coronary dominance for various adverse clinical events following the implantation of drug-eluting stents.
  
  
  RESULTS
  We assessed two-year follow-up data of 1,387 patients from the randomised TWENTE trial. Based on the origin of the posterior descending coronary artery, coronary circulation was categorised into left and non-left dominance (i.e., right and balanced). Target vessel-related myocardial infarction (MI) was defined according to the updated Academic Research Consortium (ARC) definition (2x upper reference limit of creatine kinase [CK], confirmed by CK-MB elevation), and periprocedural MI (PMI) as MI ≤48 hours following PCI. One hundred and thirty-six patients (9.8%) had left and 1,251 (90.2%) non-left dominance. Target lesions were more frequently located in dominant arteries (p<0.005). Left dominance was associated with more severe calcifications (p=0.006) and more bifurcation lesions (p=0.031). Non-left dominance tended to be less frequent in men (p=0.09). Left coronary dominance was associated with more target vessel-related MI (14 [10.3%] vs. 62 [5.0%], p=0.009). Left dominance independently predicted PMI (adjusted HR 2.19, 95% CI: 1.15-4.15, p=0.017), while no difference in other clinical endpoints was observed between dominance groups.
  
  
  CONCLUSIONS
  In the population of the TWENTE trial, we observed a higher incidence of periprocedural myocardial infarction in patients who had left coronary dominance.
authors.affiliation: Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Ming Kai
authors.initials: MK
authors.lastname: Lam
authors.forename: Kenneth
authors.initials: K
authors.lastname: Tandjung
authors.forename: Hanim
authors.initials: H
authors.lastname: Sen
authors.forename: Mounir W Z
authors.initials: MW
authors.lastname: Basalus
authors.forename: K Gert
authors.initials: KG
authors.lastname: van Houwelingen
authors.forename: Martin G
authors.initials: MG
authors.lastname: Stoel
authors.forename: Johannes W
authors.initials: JW
authors.lastname: Louwerenburg
authors.forename: Gerard C M
authors.initials: GC
authors.lastname: Linssen
authors.forename: Salah A M
authors.initials: SA
authors.lastname: Saïd
authors.forename: Mark B
authors.initials: MB
authors.lastname: Nienhuis
authors.forename: Frits H A F
authors.initials: FH
authors.lastname: de Man
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
authors.forename: Clemens
authors.initials: C
authors.lastname: von Birgelen
mesh_terms: D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome