A CROSS-SECTIONAL EVALUATION OF CORONARY ARTERY ANATOMY AND ISCHEMIC HEART DISEASE SEVERITY

Abstract

Background:  The anatomy of coronary arteries plays an important role in the pathophysiology, presentation, and prognosis of ischemic heart disease (IHD). Increasing knowledge concerning anatomical variation including coronary dominance, arterial branching and vessel caliber can enhance accuracy of diagnosis and therapeutic planning. The purpose of this research was to evaluate the correlations between coronary artery anatomy and the extent of IHD in a tertiary care living population.

Methods: A cross-sectional study that employed a retrospective sample consisted of 214 coronary angiograms of individuals diagnosed with IHD at a tertiary heart center between January 2022 and December 2023. The primary anatomical parameters evaluated were coronary dominance (right, left, or co-dominant), vessel number diseased, developing bifurcation pattern and vessel diameter. The SYNTAX scoring system was applied to classify the disease severity, and stratified into low (<22), intermediate (23-32) and high (>33) groups. Chi-square and ANOVA tests were used to examine statistics where p < 0.05 was significant.

Results: Of the 214 patients (mean age 61.7 and SD 10.5 years, 68 percent were male), right dominance was experienced in 62.1 percent of patients, left dominance in 28.5 percent, and co-dominance in 9.3 percent. Left dominance showed a significantly higher occurrence of high SYNTAX scores (p = 0.002). Some 34% of left-dominant patients had triple-vessel versus 17% right-dominants. Moreover, 46.7% of patients with high SYNTAX had complex bifurcations (Type B and C lesions). There was a strong correlation (r = 0.61, p < 0.001) between decreased luminal diameter of the left anterior descending artery and severity increase of IHD.

Conclusion: The study proves that anatomical aspects of the coronaries (especially left coronary dominance and its arterial branching variety) are importantly linked to the increased ischemic load and the complexity of the disease in IHD patients.