The Influence of Coronary Dominance on Coronary Atherosclerosis and Distribution of Coronary Artery Disease in Korean

Background and Objectives:Common anatomical variations exist within the coronary arteries. The coronary arteries are equally exposed to systemic risk factors; however, coronary angiography has shown a focal and uneven distribution of atherosclerosis. We hypothesized that the nature of coronary arteries, such as the coronary dominance, is one of the local factors able to determine the morphology and progression of atherosclerotic plaques. The relationship between the coronary dominance and the distribution of coronary artery atherosclerosis; however, remains to be investigated. Subjects and Methods:A total 264 patients were enrolled for analysis. Using the ACC/AHA definition, the coronary dominance was assessed as either a right dominant, left dominant or balanced dominant artery. The degree of the coronary artery stenosis was obtained using a scoring system. By means of the sum of the numerical values in the three vessels, the total left anterior descending artery (LAD), total left circumflex artery (LCX) and total right coronary artery (RCA) scores were calculated. Results:Of the 264 patients, right, left and balanced dominance was found in 73.5, 16.3 and 10.2%, respectively. The total LAD, LCX and RCA scores were similar in the patients from all three dominance groups (p>0.05). The score for coronary artery disease were shown to be higher in the proximal and mid segments (LAD, p=0.000; LCX, p=0.002; RCA, p=0.041). Conclusion:The coronary dominance was not found to relate to the angiographic severity of coronary artery disease. The distribution of coronary disease in the three coronary arteries tended to cluster within the proximal and mid segments of the vessels. (Korean Circulation J 2006;36:46-52)