Clinical Significance of Coronary Arterial Dominance: A Review of the Literature.

Coronary dominance describes the anatomic variation of coronary arterial supply, notably as it relates to perfusion of the inferior cardiac territories. Differences in the development and outcome in select disease states between coronary dominance patterns are increasingly recognized. In particular, observational studies have identified higher prevalence of poor outcomes in left coronary dominance in the setting of ischemic, conduction, and valvular disease. In this qualitative literature review, we summarize anatomic, physiologic, and clinical implications of differences in coronary dominance to highlight current understanding and gaps in the literature that should warrant further studies.

Diagnostic value of electrocardiographic indices in discriminating the culprit vessel based on the coronary dominancy in inferior acute myocardial infarction.

BACKGROUND: Identifying the culprit during inferior myocardial infarction (MI) is still challenging. We determined the diagnostic effect of electrocardiographic (ECG) indices in identifying the culprit vessel of acute MI and the impact of coronary artery dominance on it. METHODS: This cross-sectional study included patients with acute inferior MI who presented to Imam Khomeini Hospital and Tehran Heart Center and underwent primary PCI within 12 h of the onset of symptoms. A standard 12­lead ECG was recorded and interpreted by two cardiologists. Based on the coronary angiography, the patients were divided into two groups of LCX or RCA involvement and were compared for general variables and ECG indices. The diagnostic values of the ECG indices for predicting the culprit vessel were then calculated. RESULTS: We evaluated 411 patients with inferior STEMI (321 [77.5%] male, age 58.1 ± 11.1 years). RCA was the culprit vessel in 286 patients (69.1%) and LCX in 128 patients (30.9%). 321 patients (77.5%) were right dominant, 40 (9.7%) patients were left dominant, and 53 patients (12.8%), were codominant. Coronary dominance had minimal impact on the ECG indices regarding culprit identification even after adjustment for confounders. STE in lead III > lead II had the highest sensitivity for detecting RCA as the culprit (sensitivity: 89.2% and specificity: 57.8%). STE ≥0.1 mV in V5 or V6 leads had the highest sensitivity for detecting LCX as the culprit (sensitivity: 51.6, specificity: 93.7%). CONCLUSION: In inferior STEMI, ECG indices can predict the culprit vessel with acceptable sensitivity and specificity independent of coronary artery dominance.

Coronary anatomy in neotropical carnivores: A comparative analysis.

This study aims to investigate the anatomy of coronary arteries and their primary branches in neotropical carnivores, given the functional significance of coronary circulation and the limited existing descriptions in this order. For this purpose, coronary arteries were dissected, and their branches were counted in 74 hearts from 20 species belonging to five families: Canidae, Mustelidae, Procyonidae, Mephitidae, and Felidae. In all specimens of the suborder Caniformia, the subsinuosal interventricular branch originated at the end of the circumflex branch of the left coronary artery (LCA). In contrast, in all hearts of Felidae specimens, the subsinuosal branch was derived from the right coronary artery. Among the 50 neotropical specimens of the suborder Caniformia, 13.1 ± 5.2 ventricular branches originated from the LCA and only 4.6 ± 1.4 from the right (p < 0.0001), characterizing a consistent left dominance. However, in the 24 specimens of the Felidae family, 10.5 ± 4.0 ventricular branches were found originating from the LCA and 10.4 ± 3.4 from the right, with no difference between the means (p = 0.82), defining a balanced pattern. It is suggested that the type of coronary circulation may correlate with the phylogeny of carnivorans.

Comparison of coronary arteries morphometry and distribution in bovines with humans and other animal species.

Background: The left coronary artery (LCA) in the bovines is more developed than the right. Aim: The objective of the study is to describe the bovine coronary system from a morphological point of view, including the morphometry and its distribution. Methods: Arciform suture with 2.0 silk was applied around the sinus orifice and coronary ostium and a number 14 catheter was installed, to perfuse semi-synthetic polyester resin, consisting of a mixture of 85% GP40L palatal with 15% styrene with red color mineral. Results: The average weight of 28 bovine hearts used in our study was 1.534.1 kg. The right coronary artery had a proximal caliber of 5 +/- 0.9 mm. The LCA caliber and length were 9.4 +/- 1.2 and 18.3 +/- 4.8 mm, respectively. This artery was divided into two branches in 85.7% of the cases and trifurcated in 14.3%. The paraconal interventricular branch (PIB) ended more frequently in the apex (46.4%), and its proximal caliber was 6.4 +/- 1.4 mm. The left circumflex branch ended in 82.1% in the subsinusal interventricular sulcus, and its proximal caliber was 5.9 +/- 1.2 mm. The proximal calibers of the PIB and the left circumflex branch did not present statistically significant differences (p = 0.137). The sinoatrial branch presented a dual origin (right and LCA) in 46.4% of the cases and a single origin from the LCA in 53.6% of the samples. In the evaluated hearts, left coronary dominance was observed in most cases (96.4%). Their presence of anastomosis between the branches of the coronary arteries was observed in 57.1% of cases. Conclusion: The presence of a myocardial bridge was found in six hearts (21.4%). In bovines, a high percentage of anastomosis was found, a protective factor in obstruction of the coronary arterial branches.

The Association of Severe Coronary Tortuosity and Non-Obstructive Coronary Artery Disease.

Background and Objectives: There is an increasing interest in the coronary tortuosity as a novel pathophysiological mechanism of ischemia in coronary artery disease without significant obstruction, but there are a lack of studies to confirm this relationship in the clinical setting. The aim of our study was to evaluate the association of severe coronary tortuosity and the potential role of coronary blood supply dominance in the appearance of myocardial ischemia in patients with non-obstructive coronary artery disease (non-CAD), compared to patients with obstructive coronary artery disease (CAD). Materials and Methods: The study enrolled 131 participants (71 male and 60 female), recruited among patients referred to cardiologists due to angina symptoms with ischemic alterations established by cardiac stress tests, as well as those admitted to the hospital for acute coronary syndrome. Results: Mean age of recruited patients was 61.6 (±10.1) years. According to the coronary angiography, they were divided into two groups: non-obstructive and obstructive CAD (77 and 54, respectively). There were significantly more women (61% vs. 24%, p < 0.001) in the non-CAD group. Both tortuous coronary arteries (50.6% vs. 14.8%, p < 0.001) and left coronary dominance (37.7% vs. 16.7%, p = 0.006) were more frequent in the non-CAD group compared to the CAD group. Female sex (OR = 17.516, p = 0.001), tortuous coronary arteries (OR = 7.962, p = 0.006) and left dominance of blood supply were significant predictors for non-CAD. Conclusions: Non-obstructive CAD is common among patients, especially women, who are referred for coronary angiography. Severe coronary artery tortuosity is the strongest independent predictor of non-obstructive CAD, followed by female gender and left coronary dominance.

Non-dominant right coronary artery (RCA) is associated with suspected inferior ischemia on SPECT in patients without significant coronary artery disease (CAD).

OBJECTIVE: There is a huge uncertainty in the medical community regarding the significance of non-dominant right coronary artery (RCA) in patients with inferior wall ischemia on myocardial perfusion single-photon emission computed tomography (SPECT). The purpose of this study is to determine the effect of non-dominant RCA on myocardial perfusion SPECT (MPS) with respect to the misleading detection of ischemia in the inferior wall of the myocardium. METHODS: This is a retrospective study of 155 patients, who had undergone elective coronary angiography owing to an indication of inferior wall ischemia by MPS between 2012 and 2017. Patients were divided into two groups based on the coronary dominance: group 1 (n = 107), if RCA is the dominant artery, and group 2 (n = 48), if there are dominance of left artery and codominance of both arteries. Obstructive CAD was diagnosed in the case of stenosis that had severity greater than 50%. The positive predictive value (PPV), which was calculated as per the correlation between the inferior wall ischemia in MPS and obstruction level in RCA, was compared in both groups. RESULTS: Majority of patients were male (109, 70%) and the mean age was 59.5 ± 10.2. There were 45 patients with obstructive RCA disease (PPV: 42%) among 107 patients in group 1, whereas there were only 8 patients with obstructive coronary artery disease (CAD) in RCA among 48 patients in group 2, (PPV: 16% and p = 0.004). CONCLUSIONS: The results demonstrated that non-dominant RCA is associated with false-positive detection of inferior wall ischemia via MPS.

Impact of right coronary artery dominance on the long-term mortality in the patients with acute total/subtotal occlusion of unprotected left main coronary artery.

BACKGROUND: Patients with a right dominant coronary artery anatomy account for a significant proportion of acute myocardial infarction cases, and this condition is associated with a better prognosis. However, there are limited data on the impact of coronary dominance on patients with acute total/subtotal occlusion of unprotected left main coronary artery (ULMCA). METHODS: This study aimed to assess the impact of right coronary artery (RCA) dominance on long-term mortality in patients with acute total/subtotal occlusion of the ULMCA. From a multicenter registry, 132 cases of consecutive patients who had undergone emergent percutaneous coronary intervention (PCI) due to acute total/subtotal occlusion of the ULMCA were reviewed. RESULTS: Patients were classified into two groups according to the size of their RCA (dominant RCA group, n = 29; non-dominant RCA group, n = 103). Long-term outcomes were examined according to the presence of dominant RCA. Cardiopulmonary arrest (CPA) occurred in 52.3 % of patients before revascularization. All-cause death was significantly lower in the dominant RCA group than in the non-dominant RCA group. In the Cox regression model, dominant RCA was an independent predictor of all-cause death, as well as total occlusion of ULMCA, collateral from RCA, chronic kidney disease, and CPA. Patients were further analyzed according to the degree of stenosis of the ULMCA; patients with non-dominant RCA and total occlusive ULMCA had the worst outcome compared with the other groups. CONCLUSIONS: A dominant RCA might improve long-term mortality in patients with acute total/subtotal occlusion of the ULMCA who were treated with PCI.

The Relationship Between Coronary Dominance and Positive Results in Myocardial Perfusion Imaging.

Objective Our study aims to evaluate the possible relationship between coronary artery dominance and its effect on accurately identifying reversible ischemia of inferior/inferior-lateral wall on cardiac perfusion imaging. Background Coronary artery dominance is conventionally defined by the vessel which gives the rise to the AV nodal artery/posterior descending artery (PDA). Previous studies have explored the potential effect of coronary dominance on the accuracy of single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) tests in detecting inferior/inferior-lateral wall ischemia; further evidence is necessary to study that potential effect. Methods We conducted a single-center retrospective analysis to explore the potential relationship between coronary artery dominance and inferior/inferior-lateral wall ischemia on SPECT imaging. We identified a cohort of patients with a reversible defect(s) in the inferior and/or inferolateral walls on SPECT MPI who had subsequently undergone invasive coronary angiography. Coronary angiography was used to determine coronary dominance and to confirm the presence/absence of obstructive coronary artery disease in the distribution of the inferior and/or inferolateral wall(s). We correlated the findings on SPECT MPI to coronary angiography to identify true positives and false positive MPIs. Results A cohort of 200 patients was identified, patients in the cohort had undergone stress MPI with reversible defects with subsequent invasive coronary angiography. Baseline characteristics including age, BMI and sex were fairly well-balanced between the groups. The mean age was 68 +/- 11 in the right dominant group and 70 +/- 9 in the non right dominant group. One hundred and sixty-one patients (81%) were found to have right dominant circulation and 39 patients (19%) were found to have left or codominant circulation. Of the 161 patients in the right dominant group, 58 patients (36%) were found to have false positive stress MPI. Of the 39 patients in the left or codominant group, 23 patients (59%) were found to have false positive stress MPI. The incidence of false positive stress MPI in the inferior and inferolateral distribution is significantly higher in patients with non-right dominant coronary anatomy (p-value: 0.01). Conclusion Non-right coronary dominant anatomy could have high false positive MPI results in the inferior and inferolateral distribution. Therefore, the interpreting clinicians should exercise caution during the clinical evaluation of these patients.

Coronary dominance among the Indian aborted fetal hearts.

Increasing incidences of myocardial infarction and decreasing age at which they are occurring has forced many researchers to do in depth study pertaining to the anatomical variations in the vascular pattern of heart. Coronary dominancy of the heart will determine whether the territory of the heart supplied by the posterior inter ventricular artery will receive blood from right coronary artery or left coronary artery or both. Present study was conducted to explore the variations in the coronary dominant pattern in the aborted human fetal hearts. Right and left coronary arteries in 30 aborted human fetal hearts were thoroughly dissected from their commencement from the corresponding aortic sinus till their termination. The coronary dominance was determined on the basis of origin of posterior inter ventricular artery. We found 60% cases of right coronary dominance, 36.66% cases of left coronary dominance and 3.33% cases of balanced coronary dominance/ coronary co-dominance. Data shows variations in the vascular dominancy pattern of heart can be critically important for the cardiac surgeons, cardiologists as well as interventional radiologists while performing investigational or operative procedures.

Computed tomography to identify risk factors for left circumflex artery injury during mitral surgery.

OBJECTIVES: Cases in which the left circumflex coronary artery (LCX) runs close to the mitral annulus are considered high risk for LCX injury during mitral surgery. We investigated the anatomical relationship between the LCX and the mitral annulus using 3-dimensional (3D) computed tomography (CT). METHODS: We constructed 3D-CT images of the LCX and the mitral annulus before surgery in 122 patients with mitral regurgitation (MR). We classified coronary dominance by 3D-CT and MR aetiologies (degenerative, atrial functional MR, ventricular functional MR and Barlow's disease) using echocardiography. We detected the point on the mitral annulus closest to the LCX (X point) and measured the minimum distance from the LCX to the mitral annulus (mCAD). We judged whether atrioventricular disjunction existed using CT. We also investigated the factors affecting mCAD and examined how coronary dominance and MR aetiologies relate to the location of the X point. RESULTS: The median mCAD was 4.2 mm (range 0.9-11.4 mm). Considering coronary dominance and MR aetiologies, mCAD was shorter in patients with left coronary dominance and Barlow's disease. The X point mostly existed on the lateral side of the posterior annulus, but it sometimes existed on the medial side. Multiple regression revealed left dominance and mitral annular disjunction as significant factors affecting mCAD (P = 0.01). CONCLUSIONS: The anatomical relationship between the LCX and the mitral annulus can be recognized using superimposed 3D-CT images. This approach is useful to avoid LCX injury in mitral valve surgery since the X point varies between patients.

Coronary artery anatomy in peri-crux cordis area on computed coronary tomography angiography.

BACKGROUND: The peri-crux area is an anatomical structure of the heart. Unfortunately, important information on this area mainly derives from autopsy heart with a small, under-representative sample size, resulting in limited clinical applications. Furthermore, little has been done to standardize the definition of the peri-crux area on coronary computed tomography angiography (CCTA) images or to investigate coronary artery anatomy wherein potential values are attracting experienced inventional cardiologists in terms of the revascularization strategies. The current study aimed to identify the peri-crux cordis area and to observe coronary artery anatomical distributions in this area on CCTA. METHODS: A total of 1,006 consecutive patients undergoing CCTA exams were enrolled. We delineated the peri-crux cordis area based on the posterior interatrial sulcus, posterior interventricular sulcus (PIS), left and right posterior atrioventricular groove on the diaphragmatic surface of the heart. Then we observed the coronary artery distributions in the peri-crux cordis area in different sexes. RESULTS: We have defined the peri-crux cordis area according to the anatomical landmarks on the diaphragmatic surface of the heart on CCTA images. We have observed 8 coronary artery distributions in the peri-crux cordis area. Right dominance has 4 types (types 1-4); left, 1 type (type 0) and balanced, 3 types (types 5-7). Out of the 1,006 cases, the type 1 is commonest with 834 cases (82.9%). There are no statistically significant differences in terms of coronary dominances and coronary artery distributions in the peri-crux cordis area between sexes (P>0.05). CONCLUSIONS: We have defined the peri-crux cordis area utilizing the anatomical landmarks of the heart on CCTA images, where 8 types of coronary artery distributions have been identified. The current study may provide interventional cardiologists with useful information on recognition of coronary artery dominance, use of collateral channels for revascularization of chronic total occluded lesions, and evaluation of prognosis in patients with coronary artery disease (CAD).

Association between coronary dominance and acute inferior myocardial infarction: a matched, case-control study.

BACKGROUND: Previous studies have found a connection between left coronary artery dominance and worse prognoses in patient with acute coronary syndrome, which remains a predominant cause of morbidity and mortality globally. The aim of this study was to investigate whether coronary dominance is associated with the incidence of acute inferior myocardial infarction (MI). METHODS: Between January 2011 and November 2014, 265 patients with acute inferior MI and 530 age-matched and sex-matched controls were recruited for a case-control study in the Second Affiliated Hospital of Xi'an Jiaotong University in Xi'an, China. All participants underwent coronary angiography. The exclusion criteria included history of coronary artery bypass graft surgery, chronic or systemic diseases (including hepatic failure, kidney failure, hypothyroidism and Grave's disease), ventricular fibrillation, and known allergy to iodinated contrast agent. Patients with left- or co-dominant anatomies were placed into the LD group and those with right-dominant anatomy were included in the RD group. The association of acute inferior MI and coronary dominant anatomy were assessed using multivariable conditional logistic regression, and to estimate the odds ratio (OR) and 95% confidence interval (95%CI). RESULTS: Distributions of right dominance were significantly different between the acute inferior MI group and control group (94.0% vs. 87.9%, P = 0.018). Univariable conditional logistic regression revealed that right dominance may be a risk factor for the incident acute inferior MI (OR: 2.137; 95% CI: 1.210-3.776; P = 0.009). After adjusting for baseline systolic blood pressure, heart rate, smoking status, diabetes mellitus, hypertension, hyperlipidaemia, and family history of coronary artery disease, results of multivariate conditional logistic regression showed that right dominance was associated with the incidence of acute inferior MI (OR: 2.396; 95% CI: 1.328-4.321; P = 0.004). CONCLUSIONS: Right coronary dominance may play a disadvantageous role in the incidence of acute inferior MI. However, further studies are needed to verify our findings, especially with regard to the underlying mechanisms.

Coronary dominance and prognosis in patients with chronic total occlusion treated with percutaneous coronary intervention.

AIM: The prognostic value of coronary artery dominance pattern in patients with chronic total occlusions (CTO) is unknown. The aim of this study was to assess the influence of coronary vessel dominance on short and long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) for CTO. METHODS AND RESULTS: Our study population consisted of 2002 consecutive patients (17% females, mean age 65.2 ± 10.7 years) who underwent PCI of at least one coronary CTO lesion at our center between 01/2005 and 12/2013. Based on the origin of the posterior descending coronary artery, coronary circulation was categorised into left, right, and balanced coronary dominance. Right coronary dominance (RD) was present in 88% (n = 1759), left coronary dominance (LD) in 7% (n = 136), and balanced coronary dominance (BD) in 5% (n = 107) of the study population. After a median follow-up duration of 2.6 years [interquartile range 1.1-3.1 years] all-cause mortality was significantly higher in patients with LD as compared with RD and BD (log rank = 0.001). Accordingly, the presence of a LD system was identified as a significant predictor for all-cause mortality (adjusted HR 1.7, 95% CI: 1.2-2.6, P = .007) and major adverse cardiac events (MACE) (adjusted HR 1.4, 95% CI: 1.1-1.8, P = 0.02). CONCLUSION: Our data suggest that LD is an independent predictor of increased all-cause death and MACE in patients with CTO. Therefore, assessment of coronary vessel dominance by angiography may contribute to risk stratification in these patients.

Coronary irrigation in Puma concolor (Carnivora: Felidae) / Irrigación coronaria en Puma concolor (Carnivora: Felidae)

This study described the anatomy of the coronary arteries and their main branches in Puma concolor. The hearts of six individuals of Puma concolor, were analyzed. The A. coronaria sinistra formed the ramus interventricularis paraconalis and the ramus circunflexus. A ramus septal was formed close to the origin of the ramus interventricularis paraconalis and yielded from six to eight ventricular branches. The circumflex branch originated from two to five atrial branches and from three to seven ventricular branches. The right coronary artery formed two to six atrial branches, and four to nine ventricular branches. In half of the individuals, an accessory coronary artery was identified as the first branch of the right coronary artery. In all individuals, the subsinusal interventricular branch originated in the right coronary artery. It could be inferred that coronary circulation in Puma concolor is balanced, as each coronary artery yielded an interventricular branch and there was no significant difference in the total number of branches that originated from each coronary artery. These findings are different from the descriptions of most carnivore species, and may aid a better understanding of the phylogenetic relationships and synapomorphies of carnivore coronary circulation, especially in the Felidae family.

En este estudio se describió la anatomía de las arterias coronarias, y sus principales ramas, en el Puma concolor. Se analizaron los corazones de seis especímenes de Puma concolor. La arteria coronaria izquierda formó la rama interventricular paraconal y la rama circunfleja. Una rama septal se formó cerca del origen de la rama paraconal y otorgó de seis a ocho ramas ventriculares. La rama circunfleja originó de dos a cinco ramas atriales y de tres a siete ramas ventriculares. La arteria coronaria derecha originó de dos a seis ramas atriales y de cuatro a nueve ramas ventriculares. En la mitad de los especímenes, se identificó una arteria coronaria accesoria como la primera rama de la arteria coronaria derecha. En todos los individuos, la rama interventricular subsinusal se originó en la arteria coronaria derecha. Se podría inferir que la circulación coronaria en el Puma concolor es equilibrada, ya que cada arteria coronaria produce una rama interventricular y no hay diferencia significativa en el número total de ramas que se originan de cada arteria coronaria. Estos hallazgos son diferentes de las descripciones de la mayoría de las especies carnívoras y pueden ayudar a una mejor comprensión de las relaciones filogenéticas y de las sinapomorfias de la circulación de los carnívoros, especialmente en la familia Felidae.

Volume and dimensions of angiographically normal coronary arteries assessed by multidetector computed tomography.

BACKGROUND: The objective of this study was to determine normal values for coronary artery volume (CAV) and individual vasculature and segment dimensions. METHODS: We examined 200 healthy volunteers with an Agatston score of 0 and a normal, high quality coronary CTA. Using 320 slice multidetector row CT and designated vessel tracing software with border detection algorithm, the main coronary arteries and branches were delineated and total and segmental dimensions calculated. RESULTS: 2931 segments (98.9%) could be adequately delineated. Of the 173 subjects with adequate coronary delineations, 140 subjects (81%) received nitroglycerin (NTG) prior to the scan. CAV was 4.33 ml (95% CI: 2.27-6.39) in subjects with NTG and 2.55 ml (95% CI: 0.34-4.76) in subjects without NTG (p < 0.0001). Left ventricular mass (LVM) was strongly correlated with CAV (p < 0.0001) independently of body surface area and gender, whereas gender was not independently correlated with CAV. From right, balanced to left coronary dominance, the left anterior descending artery vasculature mean contribution to CAV increased slightly (37%, 40% and 43%, p = 0.002), and the mean contributions of right coronary artery (RCA) and left circumflex artery (LCX) vasculature was inversely related - from right, balanced to left 46%, 32% and 16% for RCA (p < 0.0001); and 16%, 27% and 38% for LCX (p < 0.0001). CONCLUSION: Normal values for coronary artery volume as assessed by coronary CTA are reported. They strongly correlate with NTG administration and left ventricular mass. The respective contribution of the left and right coronary vascularture is influenced by coronary dominance.

Left dominant circulation increases mortality in acute coronary syndrome: A systematic review and meta-analysis of observational studies involving 255,718 patients.

BACKGROUND: The effect of coronary dominance on mortality in patients with acute coronary syndrome (ACS) remains unclear. We performed a meta-analysis to evaluate the effect of coronary dominance in patients with ACS. METHODS: Several data sources were searched for studies which compared studies that compared outcomes between right and left dominant coronary circulation in patients with ACS. The measured outcomes were in-hospital, 30-day or long-term mortality as reported in individual studies. The Generic inverse variance method was used in a random-effects model to pool mortality as an outcome. Odds ratio (OR) was calculated for mortality in the left dominant circulation relative to a right dominant one. Sub-group analysis was performed after stratification of mortality by duration. RESULTS: A total of 5 studies with 8 comparisons and 255,718 participants revealed an increased risk mortality (OR = 1.27 (95% CI: 1.13 - 1.42; P < 0.0001; I(2) = 34%). Sub-group analysis revealed that the increased risk was evident at all time periods after the ACS; in-hospital (OR = 1.37; 95% CI: 1.07 - 1.76; P = 0.01; I(2) = 50%), at 30 days (OR = 1.69; 95% CI: 1.14 - 2.52; P = 0.009; I(2) = 18%) and long-term (OR = 1.15; 95% CI: 1.03 - 1.28; P = 0.01; I(2) = 0%). CONCLUSIONS: In this meta-analysis we found that there is an increased risk of mortality with LD coronary circulation in patients with ACS. The knowledge of coronary dominance may not only be helpful as an incremental prognostic factor beyond pre-procedural risk scores in all patients with ACS, but may also aid in clinical decision making in a subset of these patients. © 2015 Wiley Periodicals, Inc.

Coronary Artery Dominance and Long-term Prognosis in Patients With ST-segment Elevation Myocardial Infarction Treated With Primary Angioplasty.

INTRODUCTION AND OBJECTIVES: The long-term prognostic significance of coronary artery dominance pattern in patients with ST-segment elevation myocardial infarction is poorly characterized. We investigated the prognosis of such patients according to whether they had right dominance, left dominance, or codominance. METHODS: This was a retrospective study of 767 patients, who were admitted to hospital between 2007 and 2012 with ST-segment elevation myocardial infarction and treated with primary percutaneous coronary intervention. We determined the effect of the coronary dominance pattern on all-cause mortality and readmission for infarction, adjusting for mortality as a competing event. RESULTS: A total of 80.9% of patients had right coronary dominance, and 8.6% had left coronary dominance. Over 40.8 months' [interquartile range, 21.9-58.3 months] follow-up, 118 (15.4%) deaths were recorded, of which 39 (5.1%) were in hospital. Mortality for right dominance, left dominance, and codominance was 7.1%, 36.4%, and 13.8% (P ˂ .001), respectively. Cause of death was cardiovascular in 7.1%, 21.2%, and 2.4%. On Cox multivariate analysis, left dominance was significantly associated with mortality (hazard ratio = 1.76; P = .02). Taking "coronary dominance" into account in prediction of risk of death improved the discrimination and calibration capacity of GRACE (Global Registry of Acute Coronary Events) scoring. At follow-up, 9.3% (71 patients) had reinfarction. On multivariate analysis, left dominance was an independent predictor of reinfarction (subhazard ratio = 2.06; P = .01). CONCLUSIONS: In ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention, left coronary artery dominance confers a higher risk of death and reinfarction than right coronary artery dominance, and should be included in prognostic stratification.

Evaluation of coronary dominance in pigs; a comparative study with findings in human hearts / Avaliação da dominância coronária em suínos. Estudo comparativo com os achados em corações humanos

Coronary dominance in swine has been poorly evaluated. The frequencies of each type of dominance have been described, but few details have been given as to the different expressions of each one. The aim of this study was to characterize coronary dominance in commercial breed swine. One hundred and fifty eight pig hearts were evaluated. The coronary arteries (CA) were infused with synthetic resin (Palatal 85% and Styrene15%) through the ostia after channeling. The coronary artery that gives origin to the posterior interventricular artery (PIA), and the site of termination of both the circumflex arteries (CXA), and left retroventricular branch (LRVB) were determined in order to establish the coronary dominance pattern. Right coronary dominance was found in 105 hearts (66.5%), and a balanced circulation in 53 specimens (33.5%). No dominance was observed for the left coronary artery in the hearts studied. The CXA ended on the posterior aspect of the left ventricle in 101 samples (64%) and on the crux cordis in 55 specimens (34.8%). In two specimens (1.3%) it ended as a left marginal artery. In all cases the PIA was a branch of the RCA, and was long in 105 hearts (66%), 55% of which corresponded to males and 45% to females, but this difference was not statistically significant (p=0.77). The AIA ended on the apex in 126 specimens (80%), 71 of which (56%) corresponded to males and 55 (44%) to females (p=0.74)...

A dominância coronária em suínos tem sido pouco avaliada. Descreveram-se as frequências de cada um dos tipos, mas não detalharam as diferentes expressões de cada um deles. O objetivo deste estudo foi caracterizar a dominância coronária em suínos de raças comerciais. Avaliaram-se 158 corações de suínos. As artérias coronárias (AC) foram infundidas através da canalização dos seus ostium com resina sintética (Palatal 85% e Estireno15%). Para estabelecer o tipo de dominância coronária, determinou-se de qual coronária desprendia-se a artéria interventricular posterior (AIP) e o lugar de finalização das artérias circunflexa (ACX) e do ramo retro ventricular esquerdo (RRVI). Encontrou-se dominância coronária direita em 105 corações (66%) e circulação balanceada em 53 exemplares (34%). Não foi observada a dominância coronária esquerda nos corações estudados. O calibre proximal e médio da ACD nos casos de dominância coronária direita foi de 3,84 ± 0,80 mm. Por outro lado, encontrou-se que este mesmo calibre nos corações com dominância coronária balanceada foi de 3,97 + 0,79 mm. (p=0,88). A ACX finalizou-se na face posterior do ventrículo esquerdo em 101 amostras (64%) e na crux cordis em 55 exemplares (34,8%). A AIP emergiu em todos os casos da ACD sendo comprida em 105 corações (66%) dos quais 55% correspondia a machos e 45% a fêmeas, sem que esta diferença fosse estatisticamente significativa (p=0,77). A AIA finalizou-se no ápice em 126 exemplares (80%), dos quais 71 (56%) corresponderam a machos e 55 (44%) a fêmeas (p=0,74)...

Coronary dominance and prognosis in patients undergoing coronary computed tomographic angiography: results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry.

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 patients with 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.

Anatomic parameters of the left coronary artery: an angiographic study in a south african population / Parámetros anatómicos de la arteria coronaria izquierda: estudio angiográfico en una población sudafricana

An understanding of the left coronary artery (LCA) anatomy is important for accurate diagnosis and therapeutic intervention in the management of coronary arterial diseases. This angiographic study aims to document the parameters of the LCA that may be of importance in the diagnosis and treatment of coronary artery diseases. An analysis of 151 coronary angiograms obtained from the cardiac catheterization laboratory in the eThekwini Municipality area of KwaZulu-Natal, South Africa was performed. The mean length and diameter of the LCA were 10.4+/-4.1 mm (range 2.8-23.9 mm) and 3.8+/-0.8 mm (range 2.1-6.5 mm), respectively. The mean angle of division between the two main branches was 86.2°+/-26.1° (range 27°-68.5°). There was a positive correlation between the length and the angle of division of the LCA, with the longest LCAs having the largest angle of division. The branching patterns of the LCA were 80.8 percent, 18.5 percent and 0.7 percent for bifurcation, trifurcation and quadrifurcation, respectively. Coronary arterial dominance was 81.5 percent, 15.2 percent, and 3.3 percent for right, left, and co-dominance, respectively. This study corroborated earlier findings that the longer the length, the wider the angle of LCA division. A wide angle of LCA division, the shape and disposition of the proximal tract of LCA branches may affect flow, interfere with proper deployment of stents or may predispose to earlier atherosclerotic lesions.

La comprensión anatómica de la arteria coronaria izquierda (ACI) es importante para el diagnóstico e intervención terapéutica en el tratamiento de enfermedades arteriales coronarias. Este estudio angiográfico tuvo como objetivo documentar los parámetros de la ACI que pueden ser de importancia en el diagnóstico y tratamiento de enfermedades de las arterias coronarias. Se realizó el análisis de 151 angiografías coronarias obtenidas del laboratorio de cateterización cardíaca en el área del Municipio eThekwini de KwaZulu-Natal, Sudáfrica. La longitud y diámetro promedio de la ACI fueron 10,4+/-4,1 mm (rango 2,8 a 23,9 mm) y 3,8+/-0,8 mm (rango de 2,1 hasta 6,5 mm), respectivamente. El ángulo medio de la división entre las dos ramas principales fue 86,2°+/-26,1° (rango 27°­168,5°). Hubo una correlación positiva entre la longitud y el ángulo de división de la ACI, donde las ACI más largas tuvieron un ángulo de división más grande. Los patrones de ramificación de la ACI fueron porcentualmente 80,8 por ciento, 18,5 por ciento y 0,7 por ciento para bifurcación, trifurcación y quadrifurcación, respectivamente. La dominancia arterial coronaria fue del 81,5 por ciento, 15,2 por ciento y 3,3 por ciento para la derecha, izquierda y en co-dominio, respectivamente. Este estudio corrobora hallazgos anteriores en que cuanto mayor sea la longitud, mayor será el ángulo de la división de ACI. Un amplio ángulo de la división de la ACI, la forma y la disposición del tracto proximal de las ramas de la ACI pueden afectar el flujo, interferir con el despliegue apropiado de los stents o predisponer a las lesiones ateroscleróticas tempranas.