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Correlation Between Coronary Arterial Dominance and the Degree of Coronary Artery Disease Using Computed Tomography
Haytham Al Ewaidat1, Ammar A Oglat2, Ali Al Makhadmeh1
1Department of Allied Medical Sciences-Radiologic Technology, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
Insights
Coronary artery dominance influences coronary artery disease (CAD) severity, particularly in the right coronary artery (RCA). Computed Tomography Angiography (CTA) can help identify obstructive CAD in RCA patients.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Coronary artery dominance describes the vessel that supplies blood to the inferior wall of the heart.
- Understanding the relationship between coronary dominance and coronary artery disease (CAD) severity is crucial for risk stratification and treatment planning.
Purpose of the Study:
- To evaluate the impact of coronary artery dominance (right, left, or co-dominant) on the severity of coronary artery disease (CAD).
- To assess the utility of Computed Tomography Angiography (CTA) in identifying obstructive CAD in relation to coronary dominance patterns.
Main Methods:
- Retrospective analysis of 1,000 coronary CTA scans from patients aged 18+.
- Two experienced radiologists assessed coronary stenosis severity (0%, mild, moderate, severe) and identified obstructive CAD (≥50% lumen compromise).
- Statistical analysis included descriptive statistics, t-tests, and one-way ANOVA to compare outcomes across dominance groups.
Main Results:
- Right coronary dominance was most prevalent (85.7%), followed by left (11.6%) and co-dominant (2.7%).
- Co-dominant arteries showed a significantly higher incidence of right coronary artery (RCA) issues (22.2%) and obstructive RCA lesions (14.8%) compared to left- or right-dominant patterns (p=0.001 and p=0.018, respectively).
- Coronary dominance did not significantly affect stenosis in the left main coronary artery, left anterior descending, left circumflex, or Ramus arteries.
Conclusions:
- Coronary artery dominance, particularly co-dominance, is associated with increased severity of right coronary artery disease.
- Coronary CTA is valuable for identifying obstructive CAD, especially in the RCA, and may aid in risk assessment for patients with specific dominance patterns.
- CTA may not offer additional risk information beyond stenosis assessment in patients with normal or non-significant CAD.
Objective:
This study used Computed Tomography Angiography to evaluate how coronary artery dominance affects CAD severity.
Methods:
We retrospectively examined 1,000 coronary CTA patients at five private outpatient radiography clinics in Amman, Jordan. Patients of both sexes aged 18 or older with no coronary CTA contraindications were enrolled. Two 10-year-experienced radiologists reviewed all coronary CT images with 64 slices or more without knowing the patients' medical histories.
Results:
The coronary arteries were right, left, or co-dominant. CAD: stenosis. Visual assessment of the lumen diameter rated coronary stenosis as 0%, mild (1-49%), moderate (50-69%), or severe (≥70%). Positive obstructive CAD can be identified when a coronary lesion compromises the lumen by ≥50%. A CAD patient had one, two, three, or four vascular disease. Study outcomes were assessed using descriptive statistics, t-tests, and one-way ANOVA. Right, left, and co-dominant coronary arteries predominated 85.7%, 11.6%, and 2.7%. Co-dominance caused greater right coronary artery (RCA) issues than left- or right-dominance. 22.2% of co-dominance patients reported positive RCA difficulties, compared to 6.9% and 21.0% of left- and right-dominance patients (p = 0.001). In addition, 14.8% of co-dominance patients had obstructive RCA lesions, compared to 1.7% of left-dominance and 5.3% of right-dominance (p = 0.018). The coronary dominance patterns did not affect LMCA, LAD, LCX, and Ramus blockages (p = 0.846, 0.447, 0.116, and 0.867). Calcium scores averaged 44.4 for right dominance, 41.0 for left, and 86.2 for co-dominance (p = 0.136).
Conclusion:
Coronary CTA may not provide more risk information than assessing stenosis in patients with normal arteries or non-significant CAD. However, it may aid RCA and obstructive CAD patients.
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