Abstract
BackgroundPrevious studies have demonstrated the relevance of left coronary artery dominance in the outcome and prognosis of obstructive coronary artery disease (CAD). However, no studies have investigated the influence of coronary vessel dominance on non obstructive CAD. The aim of this study was to establish the association of left and mixed dominance of the major epicardial arteries with the development of non obstructive CAD and evaluate potential sex-dependent differences in the coronary artery supply.MethodsA total of 484 patients underwent the same diagnostic procedures. The patients were divided into two groups based on their coronary angiogram results: the control group (242 patients with obstructive CAD; coronary artery stenosis of ≥50%) and the experimental group (242 patients with non obstructive CAD; coronary artery stenosis of <50%).ResultsSignificantly more women than men were affected by non obstructive CAD (P = 0.005). Left dominance was more frequent in the non obstructive CAD group than in the control group (P = 0.018) and was more pronounced in women than in men (P = 0.013). Among men with non obstructive CAD, a left supply was more frequent than a mixed supply (P = 0.012). Women with non obstructive CAD had a higher frequency of a left supply, whereas a mixed supply was less frequent in men than in patients with obstructive CAD (P = 0.013 and 0.018, respectively).ConclusionThese results suggest that left dominance (particularly in women) and the absence of a mixed supply in men could cause regional ischemia, thus affecting the development of non obstructive CAD. Furthermore, sex may determine the incidence of specific coronary artery supply types, therefore influencing disease development and prognosis.
Highlights
Previous studies have demonstrated the relevance of left coronary artery dominance in the outcome and prognosis of obstructive coronary artery disease (CAD)
In the control group, dominance of a right coronary artery supply was present in the majority of men and women (72.5% vs. 77.3%, respectively) followed by a mixed supply (13.9% vs. 16.3%, respectively)
A right coronary artery supply was dominant in both groups (74% in the non obstructive CAD vs. 77% in the obstructive CAD group)
Summary
Previous studies have demonstrated the relevance of left coronary artery dominance in the outcome and prognosis of obstructive coronary artery disease (CAD). The concept of cardiac syndrome X (CSX) was introduced to clinical practice by Kemp et al in 1973 to describe patients who developed angina during physical exercise with a normal coronary angiogram [1,2]. Over time, this term began to encompass a broader spectrum of patients, including those with angina of any cause and the absence of significant coronary vessel changes [2,3,4,5]. Since 1967, Regardless of definitions and terminology, obstructive CAD indicates ≥50% stenosis of the coronary artery as shown on coronary angiography, while non obstructive CAD indicates
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