Patterns of Coronary Artery Dominance and Association with Severity of Coronary Artery Disease at a Large Tertiary Care Hospital in Pakistan

Background: In cardiac anatomy, the term "dominance" refers to the supply of the posterior descending artery (PDA). Therefore, the PDA might arise from the left circumflex artery (LCX), the right coronary artery (RCA), or both, resulting in left dominant (LD), right dominant (RD), or co-dominant (CD) anatomy, respectively.  Few studies have examined the relationship between coronary dominance and coronary artery disease (CAD) severity. CAD severity is defined as single, double, or triple vessel disease based on degree of stenosis.  Our study intends to identify coronary dominance trends in Pakistan and show a correlation between coronary dominance and the severity of CAD. Methods: Between Jun 17, 2018 and August 4, 2018 data from coronary angiographies of 631 patients at a tertiary care hospital in Pakistan was collected. Patients were classified as LD, RD, or CD as reported in the results of coronary angiograms. We utilized a chi-square and multinomial logistic regression analyses to assess whether a correlation exists between coronary dominance and CAD severity. Results: Subjects were 78.9% RD, 10.5% LD, and 10.6% CD. A significant relation between dominance and severity of CAD was noted, ꭕ2(8, N=631) = 17.58, p=0.025. Individuals with right dominance had a greater chance of developing triple-vessel disease than single-vessel (p =0.025; OR = 0.451; 95% CI for OR: 0.224–0.906) and two-vessel disease (p = 0.029; OR = 0.471; 95% CI for OR: 0.239–0.926). Conclusion: In our study, right dominance has a positive correlation with severity of coronary artery disease.