Anatomical variations of the coronary arteries and their Physiological relevance in myocardial infarction
Anatomical variations of the coronary arteries, including differences in dominance patterns, anomalous origins, and myocardial bridging, can significantly influence myocardial perfusion and clinical outcomes in acute coronary syndromes. However, the prognostic implications of these variants in myocardial infarction (MI) remain underexplored. This study aimed to evaluate the prevalence of coronary artery anatomical variations in MI patients and assess their physiological relevance to infarct location and in-hospital outcomes. A cross-sectional observational study was conducted on 92 patients admitted with confirmed MI to a tertiary care centre between January and December 2024. Coronary angiography was used to determine coronary dominance, presence of anomalous origins, myocardial bridging, and wrap-around left anterior descending artery (LAD). Associations between anatomical variations, infarct location, and in-hospital outcomes—including cardiogenic shock, no-reflow phenomenon, and mortality—were analysed using chi-square and Fisher’s exact tests, with statistical significance set at p < 0.05. Right coronary dominance was most common (80.4%), followed by left dominance (13.0%) and co-dominance (6.5%). Left dominance was significantly associated with anterior MI (66.7% vs. 28.4% in right dominance, p = 0.01) and higher rates of cardiogenic shock (25.0% vs. 8.1%, p = 0.04) and in-hospital mortality (16.7% vs. 5.4%, p = 0.05). Myocardial bridging (10.9%) was linked to mid-LAD culprit lesions (p = 0.04), while anomalous aortic origin of a coronary artery (4.3%) showed a trend toward increased no-reflow rates, though not statistically significant. Coronary artery anatomical variations, particularly left dominance, are associated with distinct infarct patterns and worse short-term outcomes in MI patients. Routine identification of these variants during coronary angiography may improve risk stratification and inform tailored management strategies. Further multicenter studies are warranted to confirm these findings.
