Introduction

There are two main coronary arteries-Right (RCA) and Left coronary artery (LCA). Left artery supplies left atrium and left ventricle except for a strip along the posterior and inferior surface of the heart and also supplies anterosuperior 2/3 of the ventricular septum. LCA usually divide into two branches (Datta, 2000). Left anterior descending (LAD) or anterior interventricular artery (Goldberg et al., 2007). The circumflex artery (LCx). Right artery supplies the right atrium and ventricle and parts of the left chambers and atrioventricular septum. RCA divides posterior interventricular branch or posterior descending (PDA) and Right marginal artery (Datta, 2000).

The term dominance to coronary anatomy describes whether the RCA or LCx reaches the crux of heart and supplies- posterior descending artery (PDA) and postero-lateral branches (Goldberg et al., 2007). The artery supplies -the diaphragmatic surface of the heart called the posterior descending artery (PDA) refers the coronary dominance.

Coronary artery disease (CAD) is one of the most common types of diseases around the world. It is appreciated that obesity, blood pressure, smoking, diabetes, exercise, diet, cholesterol and depression were associated with, the incidence of CAD (Yan et al., 2018).

Coronary artery diseases are responsible for over 70%of sudden cardiac deaths. In the young, the primary cause of death is non-atherosclerotic coronary abnormalities. Schlesinger first proposed the right and the left dominant idea in 1940. This term used to refer to a coronary artery that gives, the posterior descending artery which supplies- the diaphragmatic surface of the heart (Shukri, Hawas, Karim, & Ali, 2014). The main aim of this study is to define the pattern of coronary arterial dominance in Maharashtra population and the relationship of coronary dominancy with Coronary artery diseases.

Materials and Methods

The study was hospital-based prospective and observational, carried out in the Cath lab in the cardiology department in Krishna hospital, Karad, Satara (Maharashtra).

Three hundred and sixty (360) patients [below 40 age-41(11.38 %) and, above 40 ages were 319(88.61%) suffering from coronary artery disease undergoing angiography was collected for this study [Male-215(59.72%) and female was 145(40.27 %).

Angiography was recommended to patients who have chest pain (angina), Pain in jaw, neck or arm, unstable angina, Congenital heart disease, abnormal heart stress test, heart attack, cardiac arrhythmia (abnormal heart rhythm).

Out of 360 patients were divided into normal (who do not have any coronary artery disease) and diseased (coronary artery disease) groups.

The patients who had a previous history of By-pass grafting and angioplasty were excluded from this study. Invasive coronary angiography was performed by either femoral or radial artery, using radio-opaque dye (OMNIPOK-50ml) that is visible by an x-ray machine (GE.INNOVA).

The procedure of research was explained to the patients, and the consent form was taken from them. The socio-demographic Proforma of all patients, the pattern of coronary arterial dominance was taken and recorded.

Cardiologists performed angiography. The cardiologist reported the dominance pattern of the artery, i.e. right dominance left dominance, and co-dominance was recorded. The data obtained were analyzed in SPSS, and the result was shown.

If posterior descending artery arises from the RCA and if at least one other branch of RCA extends in the atrioventricular groove, giving of one or more posterolateral branch to the inferior surface of Left ventricle, then the system is said - right dominant.

Suppose posterior descending artery and all postero-lateral branches arise from LCx. Then the system is said to be left dominant. In this instance, the main LCA supplies the infero- septal and inferior segment of the left ventricle.

In co-dominant circulation, the RCA gives off the PDA only, while LCx provides all the posterolateral branches (Fakhir, Rgeeb, & Ghani, 2012).

Results

The Table 1 showed the proportion of males with affected coronary artery - moderately high as compared to the proportion of females with the affected coronary artery (Chi-square=3.544, P=0.0598). However, the proportion of normal (46.38%) and affected (53.61%) is similar.

Table 2 showing Gender- wise distribution in ≤ 40 and > 40 years. The proportion of male patients with age below 40 years was double than those of female patients. However, overall patients with age below 40 years were less as compared to patients above 40 years undergoing coronary angiography.

Table 3 showing Gender-wise distribution of affected coronary artery. The proportion of Affected coronary artery patients with age above 40 years is significantly high as compared to non-affected patients. Chances of the affected artery are 2.789 times more in patients, age above 40 years as compared these with age below 40 years (Chi-square test=8.926, P=0.0028 OR:2.789(1.393-5.584). However, the proportion of affected coronary artery in males &females with age above 40 years as well as below 40 yrs.is similar (Chi-square=0.04457, P=0.8328)

Table 4 showing Gender-wise distribution of patients according to the dominant vessels. Percentage of the right dominant circulation was 161(74.19%) in male patients and 112(78.32%) in female patients. While the percentage of left dominant circulation was 26(11.98 %) for males &23(16.08%) for females. The most common pattern was right dominance, followed by a left dominant pattern and then co-dominant pattern.

Table 5 showing relation between dominant coronary pattern and the number of affected vessels, showed in Figure 5; Figure 4; Figure 3; Figure 2; Figure 1. Proportion of posterior descending of right coronary artery(RCA), Left circumflex(LCx) &C0-dominant is similar in both affected coronary artery & normal (non -affected coronary artery Chi-square=2.811, P=0.2452).

Discussion

Many authors did the study of Morphology and Morphometry of the coronary artery in different population. They used different methods for the study of dominant coronary pattern in different population in the world. Angiography is one method used in this study. We had taken other measurement like the diameter & length of the main trunk of LCA, the angle between the left anterior descending(LAD) and left circumflex artery(LCx), termination of the LAD etc. In the present study right, the dominant pattern was observed in 75.83%, which is closely similar to another study (Abdellah, Elsayed, & Hassan, 2012). While left dominant pattern in our study reported 13.6%, which is closely related to Co-dominant pattern was seen 10.55% closely similar to Hussein Ali Fakhir (Fakhir et al., 2012) and (Kulkarni, 2013). Our results are against results of the studies done by Damor in which the right dominant pattern was more than in the present study, i.e. .83%,88.18%,90%& 90.6 respectively (Bhavana, Kamlesh, Seema, & V, 2015). There was a higher percentage of LCx dominant pattern with value 19.5% by (Rehman, Hussain, Ahmad, & Mian, 2011). The result of co-dominant pattern in this study was higher (Abdellah et al., 2012). In the present study, the proportion of right dominance pattern is observed 3/4^th(79.70%) of the patients with affected coronary artery, which is similar to the study done by (Yan et al., 2018). In comparison, it is mainly with Triple vessel disease(88.33%) in this study & 87.19% in a study of Dr Hussein Ali Fakhir (Fakhir et al., 2012).

Conclusion

The present study provides information to physicians, anatomist the knowledge of coronary dominance. The study reported that patients with the right coronary dominant pattern were higher proportion in western Maharashtra. Right coronary dominant was associated with the severity of CAD, and the proportion of males with affected coronary artery is moderately high.

Acknowledgements

Nothing to report.

Conflict of Interest

The authors declare that there is no conflict of interest for this study.

Funding Support

The authors declare that they have no funding support for this study.