Coronary arterial dominance

Last revised by Arlene Campos ◉ on 19 Jun 2024

Citation, DOI, disclosures and article data

Citation:

Hacking C, Campos A, Rogalskyi V, et al. Coronary arterial dominance. Reference article, Radiopaedia.org (Accessed on 28 Mar 2025) https://doi.org/10.53347/rID-40290

DOI:

https://doi.org/10.53347/rID-40290

Permalink:

https://radiopaedia.org/articles/40290

rID:

40290

Article created:

16 Oct 2015, Craig Hacking ◉

Disclosures:

At the time the article was created Craig Hacking had no recorded disclosures.

View Craig Hacking's current disclosures

Last revised:

19 Jun 2024, Arlene Campos ◉

Disclosures:

At the time the article was last revised Arlene Campos had no financial relationships to ineligible companies to disclose.

View Arlene Campos's current disclosures

Revisions:

11 times, by 7 contributors - see full revision history and disclosures

Systems:

Cardiac

Sections:

Anatomy

Synonyms:

Dominance of the coronary arteries
Cardiac arterial dominance
Coronary artery dominance
Coronary dominance
Cardiac dominance
Dominance of coronary arteries

Coronary arterial dominance is defined by the vessel which gives rise to the posterior descending artery (PDA), which supplies the myocardium of the inferior third of the interventricular septum.

Most hearts (80-85%) are right dominant where the PDA is supplied by the right coronary artery (RCA). The remaining 15-20% of hearts are roughly equally divided between left dominant (~10%) and codominant (~20%). The strict definition of codominance can vary depending on which modality one uses to assess the coronary arteries (coronary angiography or CT coronary angiography (CTCA)) but is not overly important. In left dominant hearts the PDA is supplied by the left circumflex artery (LCx) wrapping around the left atrioventricular groove, or less commonly the left anterior descending artery (LAD) coursing around the apex of the heart. In a codominant heart a single or duplicated PDA is supplied by branches of both the RCA and the LAD or LCx.

Although the RCA is the dominant vessel in most hearts, it is important to consider that it is usually the LAD that supplies the majority of the left ventricular myocardium as well as the anterior and mid thirds of the interventricular septum.

Clinical relevance

Dominance has important implications in myocardial ischemia and infarction, imaging of the coronary arteries (CTCA and invasive coronary angiography) and the planning for coronary artery bypass grafting.