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Coronary dominance has been found to be predictive for the prognosis of patients suffering coronary emergencies. In this study, the relationship between coronary dominance and the distribution of coronary artery stenosis was investigated.
A total of 2225 patients (1545 males, mean age 58.5±10.3 years) with coronary artery disease (CAD) undergoing angiography between 2010 and 2014 were recruited in our study. RD anatomy was defined as the posterior descending artery (PDA) originating from the right coronary artery (RCA). LD anatomy was defined as one in which the PDA originated from the left circumflex artery (LCX). Co-dominant anatomy was defined when the PDA originated from the RCA in combination with a large posterolateral branch originating from the LCX reaching near the posterior interventricular groove. Patients included in the study were divided into 2 groups, based on a diagnostic coronary angiogram. Patients with left- or co-dominant anatomies were placed into the LD group (209 patients) and those with right-dominant anatomy were included in the RD group (2016 patients). Significant stenosis was defined as ≥50% luminal narrowing of the epicardial coronary arteries. Gensini Scores was also used to evaluate the severity of CAD.
There was no significantly statistic difference between the RD group and LD group in demographic characteristics and the explosion to CAD risk factor. Patients presenting with right coronary artery stenosis (40.5% vs. 29.2%; p<0.001) and three vessel disease (36.6% vs. 27.3%; p=0.033) were significantly higher in the RD group. After assessment of Gensini scores, there were statistic significance between RD group and LD group (32.3±33.6 vs. 27.5±29.5; p=0.028). Furthermore, the prevalence of inferior or posterior myocardial infarction was also significantly higher in the RD group (12.4% vs. 7.2%; p=0.025).
Right coronary dominance tends to have right coronary artery stenosis, multivessel coronary vascular lesions and inferior or posterior myocardial infarction compared with left dominant and co-dominant anatomy.