Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography: results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry.
OBJECTIVE
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.


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.


CONCLUSIONS
In our study population, survival after 5 years of follow-up did not differ significantly between patients with 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.
Department of Nuclear Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Catherine
C
Gebhard
Department of Nuclear Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Tobias A
TA
Fuchs
Department of Nuclear Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Julia
J
Stehli
Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Heidi
H
Gransar
Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Daniel S
DS
Berman
Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA.
Matthew J
MJ
Budoff
Department of Medicine, University of Erlangen, Erlangen, Germany.
Stephan
S
Achenbach
Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI, USA.
Mouaz
M
Al-Mallah
Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Daniele
D
Andreini
Cardio Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Italy Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Filippo
F
Cademartiri
Tennessee Heart and Vascular Institute, Hendersonville, TN, USA.
Tracy Q
TQ
Callister
Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea.
Hyuk-Jae
HJ
Chang
William Beaumont Hospital, Royal Oaks, MI, USA.
Kavitha M
KM
Chinnaiyan
Department of Medicine and Radiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
Benjamin J W
BJ
Chow
Baptist Cardiac and Vascular Institute, Miami, FL, USA.
Ricardo C
RC
Cury
Capitol Cardiology Associates, Albany, NY, USA.
Augustin
A
Delago
Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.
Millie J
MJ
Gomez
Division of Cardiology, Deutsches Herzzentrum München, Munich, Germany.
Martin
M
Hadamitzky
Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.
Joerg
J
Hausleiter
Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.
Niree
N
Hindoyan
Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
Gudrun
G
Feuchtner
Department of Medicine and Radiology, Seoul National University Hospital, Seoul, South Korea.
Yong-Jin
YJ
Kim
Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
Jonathon
J
Leipsic
Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.
Fay Y
FY
Lin
Cardio Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Italy.
Erica
E
Maffei
Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Gianluca
G
Pontone
William Beaumont Hospital, Royal Oaks, MI, USA.
Gilbert
G
Raff
Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Leslee J
LJ
Shaw
Department of Medicine, Walter Reed National Medical Center, Washington, DC, USA.
Todd C
TC
Villines
Duke Clinical Research Institute, Durham, NC, USA.
Allison M
AM
Dunning
Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.
James K
JK
Min
Department of Nuclear Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland pak@usz.ch.
Philipp A
PA
Kaufmann
D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D012042:Registries; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
Coronary computed tomographic angiography; Coronary dominance; Predictive value