Prevalence of left and balanced coronary arterial dominance decreases with increasing age of patients at autopsy. A postmortem coronary angiograms study

Abstract

In this large autopsy cohort, the prevalence of a left dominant or codominant coronary system decreased with increasing age. These findings could relate to a slightly higher risk of mortality in case of left versus right coronary artery occlusion.

Coronary artery dominance and the risk of adverse clinical events following percutaneous coronary intervention: insights from the prospective, randomised TWENTE trial

“…A recently published post-mortem angiography study showed that the prevalence of left and balanced dominance decreased with increasing age 3 , while we found no relation between age and dominance pattern in the population of TWENTE trial patients, who were on average at a younger age (being normally distributed) than the population of the aforementioned post-mortem study that also comprised a wider age range (with non-Gaussian distribution).…”

“…A few registries and studies have shown relations between left dominance and inferior clinical outcome [2][3][4] , but the patient populations of these studies differed significantly from that of the TWENTE trial 5 .…”

“…A recent post-mortem analysis showed a decreasing prevalence of left dominance with the increase of age, suggesting a worse prognosis for subjects with this dominance pattern 3 . The database of a registry of patients undergoing cardiac catheterisation for acute coronary syndromes has demonstrated higher all-cause mortality in patients with left dominance 4 .…”

Left dominant circulation increases mortality in acute coronary syndrome: A systematic review and meta‐analysis of observational studies involving 255,718 patients

“…As mentioned, the increased mortality may possibly be because of an unbalanced vascular supply and higher procedural risk during PCI . This explanation is supported by a post‐mortem study in which it was found that the prevalence of LD coronary circulation decreased with age reflective of a higher mortality rate in LD circulation . Moreover, one of the studies included in our meta‐analysis also showed a higher proportion of LD in patients who died .…”

Coronary anatomy as related to bicuspid aortic valve morphology

“…The mechanism of a potentially increased susceptibility to coronary events in patients with left dominant anatomy is to date unclear. A study screening postmortem angiograms showed that the prevalence of a left dominant system decreased with age, suggesting a higher death rate among patients with a left dominant coronary artery system 26. An explanation could be the larger myocardial area at risk in case of an acute myocardial infarction.…”