Left Dominant Coronary Circulation is Associated with Poorer Left Ventricular Function but Not Long-Term Mortality After ST Elevation Myocardial Infarction

Coronary Dominance and Myocardial Infarction

Abstract

Objective: To evaluate the effect of coronary dominance (CD) on the left ventricular systolic function in patients with first ST-elevational myocardial infarction (STEMI), and to evaluate the relationship between CD and long-term mortality.
Methods: We included 471 patients with first STEMI. The patients were categorized as right-dominant and left-dominant according to their CD pattern. The left ventricular Wall Motion Score Index (WMSI) and left ventricular ejection fraction (LVEF) were used to evaluate the extent of left ventricular systolic dysfunction. The COX regression regression analysis was used to assess the relationship between CD and long-term mortality.
Results: Left CD was present in 41 (8.7%) of the 471 patients. WMSI was significantly higher in the left dominant group than in the right dominant group (1.74±0.38 vs. 1.56±0.35, p=0.002). The frequency of LVEF <40% was significantly higher in patients with the left CD group than in the right CD group (39% vs. 15.8%, p<0.001). The patients with left CD had higher peak creatine kinase (CK) and CK-myocardial band levels (3269±2988 U/L vs. 2355±1511 U/L, p=0.007; 390±303 U/L vs. 241±172 U/L, p<0.001, respectively). Nevertheless, mortality was similar between the left and right dominance groups [13 (40.1%) vs. 85 (30.7%), p=0.201]. In COX regression analysis, CD was not related to long-term mortality.
Conclusion: Patients with left dominance had significantly lower left ventricular systolic function early after STEMI. However, long-term mortality was similar in patients with left and right dominant circulation.