Impact of coronary dominance on long-term outcomes in patients undergoing left main coronary artery percutaneous coronary intervention

Coronary dominance patterns are associated with the prevalence and severity of obstructive coronary artery disease (CAD), as well as with prognosis following percutaneous coronary intervention (PCI)1. The left main (LM) coronary artery supplies 75% to 100% of the left ventricular myocardium, placing the left ventricle at considerable risk in cases of significant LM stenosis, particularly in patients with left dominance2. Studies have indicated that left coronary dominance is associated with worse outcomes compared to right dominance in CAD populations; however, these studies are either outdated or lack sufficient statistical power3. Current clinical guidelines for LM PCI focus on assessment of the lesion complexity and intravascular imaging guidance to optimise stent implantation4, without explicitly considering coronary dominance as an independent factor. This study aims to evaluate the influence of coronary dominance on long-term prognosis among a large cohort of LM PCI patients.

We analysed the relationship between coronary dominance and outcomes in consecutive patients with obstructive LM disease who underwent PCI between January 2004 and December 2016 at Fuwai Hospital, Beijing, China. The primary endpoint was 3-year major...