Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography: Results from the CONFIRM (COronary CTAngiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) registry

Catherine Gebhard, Tobias A. Fuchs, Julia Stehli, Heidi Gransar, Daniel S. Berman, Matthew J. Budoff, Stephan Achenbach, Mouaz Al-Mallah, Daniele Andreini, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Kavitha M. Chinnaiyan, Benjamin J W Chow, Ricardo C. Cury, Augustin Delago, Millie J. Gomez, Martin Hadamitzky, Joerg Hausleiter, Niree HindoyanGudrun Feuchtner, Yong Jin Kim, Jonathon Leipsic, Fay Y. Lin, Erica Maffei, Gianluca Pontone, Gilbert Raff, Leslee J. Shaw, Todd C. Villines, Allison M. Dunning, James K. Min, Philipp A. Kaufmann

Research output: Contribution to journalArticle

Abstract

Aims: 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. Methods and 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. Conclusion: In our study population, survival after 5 years of follow-up did not differ significantly between patientswith 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.

Original languageEnglish
Pages (from-to)853-862
Number of pages10
JournalEuropean Heart Journal Cardiovascular Imaging
Volume16
Issue number8
DOIs
Publication statusPublished - 2015

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Registries
Angiography
Coronary Artery Disease
Coronary Vessels
Population
Pathologic Constriction
Survival

Keywords

  • Coronary computed tomographic angiography
  • Coronary dominance
  • Predictive value

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography : Results from the CONFIRM (COronary CTAngiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) registry. / Gebhard, Catherine; Fuchs, Tobias A.; Stehli, Julia; Gransar, Heidi; Berman, Daniel S.; Budoff, Matthew J.; Achenbach, Stephan; Al-Mallah, Mouaz; Andreini, Daniele; Cademartiri, Filippo; Callister, Tracy Q.; Chang, Hyuk Jae; Chinnaiyan, Kavitha M.; Chow, Benjamin J W; Cury, Ricardo C.; Delago, Augustin; Gomez, Millie J.; Hadamitzky, Martin; Hausleiter, Joerg; Hindoyan, Niree; Feuchtner, Gudrun; Kim, Yong Jin; Leipsic, Jonathon; Lin, Fay Y.; Maffei, Erica; Pontone, Gianluca; Raff, Gilbert; Shaw, Leslee J.; Villines, Todd C.; Dunning, Allison M.; Min, James K.; Kaufmann, Philipp A.

In: European Heart Journal Cardiovascular Imaging, Vol. 16, No. 8, 2015, p. 853-862.

Research output: Contribution to journalArticle

Gebhard, C, Fuchs, TA, Stehli, J, Gransar, H, Berman, DS, Budoff, MJ, Achenbach, S, Al-Mallah, M, Andreini, D, Cademartiri, F, Callister, TQ, Chang, HJ, Chinnaiyan, KM, Chow, BJW, Cury, RC, Delago, A, Gomez, MJ, Hadamitzky, M, Hausleiter, J, Hindoyan, N, Feuchtner, G, Kim, YJ, Leipsic, J, Lin, FY, Maffei, E, Pontone, G, Raff, G, Shaw, LJ, Villines, TC, Dunning, AM, Min, JK & Kaufmann, PA 2015, 'Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography: Results from the CONFIRM (COronary CTAngiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) registry', European Heart Journal Cardiovascular Imaging, vol. 16, no. 8, pp. 853-862. https://doi.org/10.1093/ehjci/jeu314
Gebhard, Catherine ; Fuchs, Tobias A. ; Stehli, Julia ; Gransar, Heidi ; Berman, Daniel S. ; Budoff, Matthew J. ; Achenbach, Stephan ; Al-Mallah, Mouaz ; Andreini, Daniele ; Cademartiri, Filippo ; Callister, Tracy Q. ; Chang, Hyuk Jae ; Chinnaiyan, Kavitha M. ; Chow, Benjamin J W ; Cury, Ricardo C. ; Delago, Augustin ; Gomez, Millie J. ; Hadamitzky, Martin ; Hausleiter, Joerg ; Hindoyan, Niree ; Feuchtner, Gudrun ; Kim, Yong Jin ; Leipsic, Jonathon ; Lin, Fay Y. ; Maffei, Erica ; Pontone, Gianluca ; Raff, Gilbert ; Shaw, Leslee J. ; Villines, Todd C. ; Dunning, Allison M. ; Min, James K. ; Kaufmann, Philipp A. / Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography : Results from the CONFIRM (COronary CTAngiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) registry. In: European Heart Journal Cardiovascular Imaging. 2015 ; Vol. 16, No. 8. pp. 853-862.
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abstract = "Aims: 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. Methods and 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. Conclusion: In our study population, survival after 5 years of follow-up did not differ significantly between patientswith 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.",
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author = "Catherine Gebhard and Fuchs, {Tobias A.} and Julia Stehli and Heidi Gransar and Berman, {Daniel S.} and Budoff, {Matthew J.} and Stephan Achenbach and Mouaz Al-Mallah and Daniele Andreini and Filippo Cademartiri and Callister, {Tracy Q.} and Chang, {Hyuk Jae} and Chinnaiyan, {Kavitha M.} and Chow, {Benjamin J W} and Cury, {Ricardo C.} and Augustin Delago and Gomez, {Millie J.} and Martin Hadamitzky and Joerg Hausleiter and Niree Hindoyan and Gudrun Feuchtner and Kim, {Yong Jin} and Jonathon Leipsic and Lin, {Fay Y.} and Erica Maffei and Gianluca Pontone and Gilbert Raff and Shaw, {Leslee J.} and Villines, {Todd C.} and Dunning, {Allison M.} and Min, {James K.} and Kaufmann, {Philipp A.}",
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TY - JOUR

T1 - Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography

T2 - Results from the CONFIRM (COronary CTAngiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) registry

AU - Gebhard, Catherine

AU - Fuchs, Tobias A.

AU - Stehli, Julia

AU - Gransar, Heidi

AU - Berman, Daniel S.

AU - Budoff, Matthew J.

AU - Achenbach, Stephan

AU - Al-Mallah, Mouaz

AU - Andreini, Daniele

AU - Cademartiri, Filippo

AU - Callister, Tracy Q.

AU - Chang, Hyuk Jae

AU - Chinnaiyan, Kavitha M.

AU - Chow, Benjamin J W

AU - Cury, Ricardo C.

AU - Delago, Augustin

AU - Gomez, Millie J.

AU - Hadamitzky, Martin

AU - Hausleiter, Joerg

AU - Hindoyan, Niree

AU - Feuchtner, Gudrun

AU - Kim, Yong Jin

AU - Leipsic, Jonathon

AU - Lin, Fay Y.

AU - Maffei, Erica

AU - Pontone, Gianluca

AU - Raff, Gilbert

AU - Shaw, Leslee J.

AU - Villines, Todd C.

AU - Dunning, Allison M.

AU - Min, James K.

AU - Kaufmann, Philipp A.

PY - 2015

Y1 - 2015

N2 - Aims: 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. Methods and 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. Conclusion: In our study population, survival after 5 years of follow-up did not differ significantly between patientswith 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.

AB - Aims: 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. Methods and 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. Conclusion: In our study population, survival after 5 years of follow-up did not differ significantly between patientswith 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.

KW - Coronary computed tomographic angiography

KW - Coronary dominance

KW - Predictive value

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DO - 10.1093/ehjci/jeu314

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