Branching patterns of the left coronary artery - a systematic review and meta-analysis
Aaron W Beger1, Ryan Baukhages2, Matthew Spano2
1Edward Via College of Osteopathic Medicine, Blacksburg, VA, United States. abeger@vcom.edu.
Insights
The left coronary artery (LCA) commonly bifurcates, but variations like trifurcation are frequent. Understanding these branching patterns is crucial for cardiac imaging and surgical planning.
Area of Science:
- Cardiovascular Anatomy
- Medical Imaging
- Surgical Planning
Background:
- The left coronary artery (LCA) is vital for coronary circulation, typically branching into the left anterior descending (LAD) and circumflex (Cx) arteries.
- Existing data on LCA branching patterns is limited to small studies, hindering comprehensive understanding.
- Aberrant LCA branching patterns are relevant for coronary angiography and preoperative planning.
Purpose of the Study:
- To conduct a comprehensive meta-analysis on the prevalence of various left coronary artery branching patterns.
- To establish a robust understanding of standard and aberrant LCA anatomy.
- To provide data supporting improved interpretation of cardiac imaging and surgical strategies.
Main Methods:
- Systematic review of major databases and anatomical journals.
- Inclusion of 85 studies with quantitative LCA branching data, totaling 23,421 LCAs.
- Meta-analysis of LCA branching rates, study continent, and methodology (imaging vs. dissection).
Main Results:
- Pooled prevalence: LCA bifurcation (68.77%), trifurcation (26.77%), tetrafurcation (1.01%), absent LCA (0.40%).
- Bifurcation rates differed significantly between imaging (75.79%) and dissection (64.22%) studies.
- Significant heterogeneity in branching patterns was observed across different continents.
Conclusions:
- The left coronary artery exhibits diverse branching patterns.
- Knowledge of LCA branching prevalence is essential for accurate imaging interpretation.
- Understanding these anatomical variations aids in preoperative planning for coronary interventions.
Background:
The left coronary artery (LCA) typically terminates by bifurcating into left anterior descending (LAD) and circumflex (Cx) branches, collectively forming a critical component of coronary circulation. Despite relevancy in coronary angiography interpretation and preoperative planning, description of standard and aberrant LCA branching pattern rates is often restricted to small-scale studies. Therefore, this study aimed to provide a comprehensive analysis of the prevalence of LCA branching patterns.
Materials And Methods:
A systematic review was conducted by searching major databases and relevant anatomical journals. Studies that provided quantitative data on LCA branching patterns were selected for inclusion. A total of 85 studies met the criteria, which encompassed a total of 23,421 LCAs. Data on LCA branching patterns rates, continent in which the study took place, and study methodology (imaging versus dissection) were extracted and analyzed via meta-analysis.
Results:
The pooled prevalence of absent LCA was 0.40%, single LCA branch (aberrant Cx origin while LCA continued as LAD) was 0.03%, LCA bifurcation was 68.77%, trifurcation was 26.77%, tetrafurcation was 1.01%, and pentafurcation was < 0.01%. Subgrouping based on methodology revealed differing LCA bifurcation rates as seen in imaging studies (75.79%) versus dissection studies (64.22%) (Q = 15.91, p < 0.01). Subgrouping based on continent in which the study took place revealed significant heterogeneity (Q = 29.26, p < 0.01).
Conclusions:
The LCA exhibits variable branching patterns, and understanding the prevalence of LCA branching patterns can support imaging interpretation and preoperative planning for coronary circulation interventions.
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