Angiographic Evaluation of Coronary Artery Variations, Calcification and Disease Burden in a South Indian Population

Abstract

Background: The coronary arterial system exhibits substantial anatomical variability in origin, branching pattern, dominance, and course, with important implications for myocardial perfusion, clinical presentation, and interventional planning. This current study is to evaluate the origin, branching patterns, and anomalies of the right and left coronary arteries in both genders using coronary angiography; to determine the pattern of coronary artery dominance; and to analyse age-wise variations in the severity of coronary artery calcification.

Methods: This cross-sectional observational study was conducted in the Cardiac Catheterization Laboratory of Mahatma Gandhi Medical College and Research Institute, Puducherry, South India. A total of 180 consecutive adult patients undergoing diagnostic coronary angiography over an 18-month period were included. Coronary artery origin, left main branching pattern, dominance, anomalies, coronary artery disease (CAD) patterns, and calcification severity were systematically assessed. Data were analysed using SPSS version 26, with categorical variables expressed as frequencies and percentages. Associations were evaluated using the Chi-square test.

Results: Right coronary artery dominance was observed in 136 patients (75.6%), followed by left dominance in 23 (12.8%) and co-dominance in 21 (11.7%). Left main coronary artery bifurcation was the predominant branching pattern (146, 81.1%), with trifurcation noted in 30 patients (16.7%). Normal coronary origin was present in 157 participants (87.2%). Coronary artery anomalies were identified in 30 patients (16.7%), most commonly myocardial bridging of the left anterior descending artery (14, 7.8%). Severe coronary calcification was observed in 23 participants (12.8%). Age showed significant associations with coronary dominance patterns (p≤0.05), coronary calcification severity (p=0.028), and CAD extent (p=0.020). Gender was not associated with anatomical variations but showed a significant association with CAD burden (p=0.001).

Conclusion: Coronary arterial anatomy remains largely consistent across genders, whereas age significantly influences calcification severity and CAD burden. Integrating anatomical assessment with age-related risk stratification is essential for optimal clinical decision-making