Effect of Coronary Artery Dominance In-terms of Presentation and In-hospital Outcomes of patients undergoing Primary PCI for Culprit Proximal Left Anterior Descending Artery

Authors

  • Lajpat Rai National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Rajesh Kumar National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Syed Ahsan Raza National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Mahesh Kumar Batra National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Zafar Iqbal Mandokhail National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Haroon Ishaque National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Muhammad Farhan Ali National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Abdul Basit National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Maria Noor Siddiqui National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Kubbra Rahooja National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Maryam Samad National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Fawad Farooq National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Zahid Ur Rehman National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Tahir Saghir National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Jawaid Akbar Sial National Institute of Cardiovascular Diseases, Karachi, Pakistan

DOI:

https://doi.org/10.47144/phj.v56i1.2460

Abstract

Objectives: Objective of this study was to assess the difference in terms of presentation and in-hospital course between patients with right vs. left dominant arterial circulation undergoing “primary percutaneous coronary intervention (PCI)” for culprit proximal left anterior descending artery (LAD).

Methodology: We included consecutive adult (≥18 years) patients diagnosed with STE-ACS undergoing primary PCI for culprit proximal LAD. Patients were categorized into right vs. left dominant circulation on left heart catheterization. Demographic, clinical characteristics, presentation, and hospital course were compared between the matched (propensity matched) and unmatched cohort of patients with right vs. left dominance.

Results: We included 775 patients, out of which 81.3% (630) were males and mean age was 54.59 ± 11.3 years. On coronary angiogram left dominance was observed in 14.3% (111). Single vessel disease was higher with left compared to right dominant system, 53.2% vs. 43.5%, respectively. The rate of slow flow/no-reflow (15.4% vs. 7.2%; p=0.0.230), heart failure (9.3% vs. 6.3%; p=0.299), and in-hospital mortality (5.1% vs. 3.6%, p=0.493) were not different between right vs. left dominance, respectively. In the matched cohorts, the frequency of slow flow/no-reflow (15.3% vs. 7.2%; p=0.056), heart failure (6.3% vs. 6.3%; p>0.999), and mortality (5.4% vs. 3.6%, p=0.493) were not different between right vs. left dominance, respectively.

Conclusion: No significant increase in complications and outcomes is witnessed among patients with left dominant arterial circulation undergoing primary PCI for culprit proximal LAD. However, careful handling of left main during intervention is warranted due lack of support from right system.

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Published

2023-04-01

How to Cite

1.
Rai L, Kumar R, Raza SA, Batra MK, Mandokhail ZI, Ishaque H, Ali MF, Basit A, Siddiqui MN, Rahooja K, Samad M, Farooq F, Rehman ZU, Saghir T, Sial JA. Effect of Coronary Artery Dominance In-terms of Presentation and In-hospital Outcomes of patients undergoing Primary PCI for Culprit Proximal Left Anterior Descending Artery. Pak Heart J [Internet]. 2023Apr.1 [cited 2024Apr.23];56(1):37-42. Available from: https://pakheartjournal.com/index.php/pk/article/view/2460

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Original Article