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Previous studies have reported a relationship between left coronary artery dominance and worse prognoses in patients with acute coronary syndrome. However, the effect of right dominance on coronary artery disease has not been well understood. The aim of this study was to investigate whether coronary dominance is associated with the incidence of acute inferior myocardial infarction (MI).
Between January 2011 and November 2014, 265 patients with acute inferior MI and 530 age-matched and sex-matched patients with non-inferior MI were recruited in this case control study. The phenotype of coronary artery dominance was classified as left dominance, right dominance and co-dominance based on the posterior descending artery originating from the right coronary artery (RCA), left circumflex artery (LCX) or both the RCA and LCX, respectively. All participants underwent coronary angiography. Multivariate logistic regression analysis was used to explore the relationship between coronary dominance and the incidence of acute inferior MI.
Distributions of right dominance, left dominance, and co-dominance were significantly different between the acute inferior MI group and control group (94.0% vs. 87.9%, 4.5% vs. 8.1%, and 1.5% vs. 4.0%, respectively; all, p=0.018). After adjusting for potential confounding factors, results of multivariate logistic regression showed that right dominance (OR=2.396; 95% CI=1.328-4.321; p=0.004), smoking (OR=2.087; 95% CI=1.460-2.984; p<0.001), and diabetes mellitus (OR=2.559; 95% CI=1.698-3.856; p<0.001) were associated with the incidence of acute inferior MI.
This study reveals that right coronary dominance may play a disadvantageous role in the incidence of acute inferior MI. Therefore, the assessment of coronary dominance may add additional value in the risk stratification for acute inferior MI in clinics. However, further prospective studies are needed to verify our findings, especially with regard to the underlying mechanisms.