الفهرس 
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Abstract
Coronary vessel dominance, defined by the coronary artery that supplies the PDA and posterolateral branches, influences the relative contribution of the different coronary arteries to the total LV blood flow.
In a RD circulation, the RCA supplies the posterior portion of the inter-ventricular septum and gives off the PDA. This contrasts with a LD circulation, in which the left circumflex (LCX) artery supplies this territory.
In a co-dominant circulation, supply of the posterior inter-ventricular septum is shared by the RCA and LCX. The prevalence of left dominance is 8%, whereas co-dominance has 7% population prevalence, and right dominant system has a reported prevalence of 82–89%. In patients with a left dominant system, 60% of the LV myocardium is supplied by the posterolateral branches and PDA originating from the LCx. This less well-balanced coronary circulation might have a negative influence on prognosis of patients with CAD. Currently, the prognostic importance of coronary vessel dominance in patients presenting with first ST-segment elevation myocardial infarction (STEMI) remains uncertain.
Variations in coronary circulation are common, particularly with regard to the supply of the posterior wall of the left ventricle. While a right dominant coronary artery is most commonly observed, a left dominant system is considered to be a normal variant of the coronary anatomy.
At present, little is known about the clinical relevance of this anatomical variation. A study screening 1620 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. An explanation could be that a larger amount of myocardium is at risk in these patients, resulting in more extensive MI in case of a left coronary artery occlusion.
However, there is limited knowledge about the relation between coronary dominance patterns and the risk of various adverse clinical events that can occur following PCI. Previously, Goldberg et al. showed that the presence of a left dominant system was associated with an increased mortality in patients presenting with ACS. Accordingly, a more recent registry (the Cath PCI registry) observed higher in-hospital mortality after PCI in patients with a left dominant system.