title: Influence of coronary vessel dominance on short- and long-term outcome in patients after ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  Prognostic importance of coronary vessel dominance in patients with ST-elevation myocardial infarction (STEMI) remains uncertain. The aim of this study was to assess influence of coronary vessel dominance on the short- and long-term outcome after STEMI.
  
  
  RESULTS
  Coronary angiographic images of consecutive patients presenting with first STEMI were retrospectively reviewed to assess coronary vessel dominance. Patients were followed after STEMI during a median period of 48 (IQR38-61) months for the occurrence of all-cause mortality and the composite of reinfarction and cardiac death. The population comprised 1131 patients of which 971 (86%) patients had a right dominant, 102 (9%) a left dominant, and 58 (5%) a balanced system. After 5 years of follow-up, the cumulative incidence of all-cause mortality was significantly higher in patients with a left dominant system, compared with a right dominant and balanced system (log-rank P = 0.013). Moreover, a left dominant system was an independent predictor for 30-day mortality (OR 2.51, 95% CI 1.11-5.67, P = 0.027) and the composite of reinfarction and cardiac death within 30-days after STEMI (OR 2.25, 95% CI 1.09-4.61, P = 0.028). In patients surviving first 30-days post-STEMI, coronary vessel dominance had no influence on long-term outcome.
  
  
  CONCLUSIONS
  A left dominant coronary artery system is associated with a significantly increased risk of 30-day mortality and early reinfarction after STEMI. After surviving the first 30-days post-STEMI, coronary vessel dominance had no influence on long-term outcome.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands The Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Veltman
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
authors.forename: Bas L
authors.initials: BL
authors.lastname: van der Hoeven
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
authors.forename: Georgette E
authors.initials: GE
authors.lastname: Hoogslag
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
authors.forename: Helèn
authors.initials: H
authors.lastname: Boden
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
authors.forename: Rohit K
authors.initials: RK
authors.lastname: Kharbanda
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands The Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.
authors.forename: Michiel A
authors.initials: MA
authors.lastname: de Graaf
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.affiliation: Biomedical Statistics, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Erik W
authors.initials: EW
authors.lastname: van Zwet
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands a.j.h.a.scholte@lumc.nl.
authors.forename: Arthur J H A
authors.initials: AJ
authors.lastname: Scholte
mesh_terms: D003326:Coronary Circulation / Q000502:physiology; D003331:Coronary Vessels / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology*; D011379:Prognosis; D012008:Recurrence
keywords: Coronary circulation; Myocardial infarction; Prognosis; Vessel dominance