Value of three-dimensional echocardiography study of left ventricle function correlated to coronary arterial dominance in predicting the outcome of primary percutaneous coronary intervention

BACKGROUND: Limited information is available regarding the relationship between coronary vessel dominance and outcome after ST-segment elevation myocardial infarction (STEMI). OBJECTIVES: The study was designed to evaluate the prognostic value of coronary arterial dominance after primary percutaneous coronary intervention (PCI) during hospital stay and at 3 months follow-up regarding cardiac mortality, heart failure, nonfatal myocardial infarction, revascularization, and stroke. PATIENTS AND METHODS: The study population consisted of 300 consecutive patients (mean age, 57.35 ± 13.41 years; 91% men) with STEMI who were admitted to Dallah Hospital (Riyadh, Saudi Arabia) from January 2015 to December 2016. These patients underwent successful primary PCI with thrombolysis in myocardial infarction (TIMI) III flow. They were divided into three groups according to angiographic coronary dominance: 227 (75.7%) in the right coronary dominant group, 40 (13.3%) in the left coronary dominant group, and 33 (11%) in the balanced coronary dominant group. They were evaluated with two- (2D) and three-dimensional (3D) echocardiography within 48 hours of admission and at 3 months follow-up after STEMI. RESULTS: Right dominance was present in 75.6%, left dominance in 13.3%, and balanced dominance was present in 11% of patients. The main finding of this study was that a left dominant system was associated with increased risk of cardiac mortality, heart failure, nonfatal myocardial infarction, revascularization, and stroke shortly after primary PCI, during hospital stay, and at 3 months follow-up after STEMI. Moreover, a significantly lower left ventricular ejection fraction at admission was observed by both 2D and 3D echocardiography in patients with a left dominant system. CONCLUSION: In patients with STEMI treated with primary PCI, left coronary artery dominance confers a higher risk of various adverse clinical events after primary PCI, during hospital stay, and at 3 months follow-up compared to right and balanced coronary artery dominance.