Clinical Significance of Coronary Arterial Dominance: A Review of the Literature

Abstract

Coronary dominance describes the anatomic variation of coronary arterial supply, notably as it relates to perfusion of the inferior cardiac territories. Differences in the development and outcome in select disease states between coronary dominance patterns are increasingly recognized. In particular, observational studies have identified higher prevalence of poor outcomes in left coronary dominance in the setting of ischemic, conduction, and valvular disease. In this qualitative literature review, we summarize anatomic, physiologic, and clinical implications of differences in coronary dominance to highlight current understanding and gaps in the literature that should warrant further studies.

Keywords: coronary artery anatomy; coronary artery disease; coronary dominance.

Figure 1. Left‐dominant system.

LAD indicates left anterior descending; LCx, left circumflex; LPDA, left posterior descending branch; OM, obtuse marginal branch; RCA, right coronary artery; and RPL, right posterior lateral branch.

Figure 2. Right‐dominant system.

LAD indicates left anterior descending; Lcx, left circumflex; PDA, posterior descending branch; RCA, right coronary artery; and RPL, right posterior lateral branch.

Figure 3. Codominant system.

LAD indicates left anterior descending; LCx, left circumflex; LPDA, left posterior descending branch; LPL, left posterior lateral branch; OM, obtuse marginal branch; RCA, right coronary artery; RPDA, right posterior descending branch; and RPL, right posterior lateral branch.

Figure 4. Summary of findings of left‐coronary‐dominant hearts compared with right coronary dominance.

ACS indicates acute coronary syndrome; CAD, coronary artery disease; LAD, left anterior descending artery; LVH, left ventricular hypertrophy; MACE, major averse cardiac events; RBBB, right bundle‐branch block; and RCA, right coronary artery.