title: Prevalence of left and balanced coronary arterial dominance decreases with increasing age of patients at autopsy. A postmortem coronary angiograms study.
abstract: BACKGROUND
  In patients presenting with an acute coronary syndrome, left over right coronary dominance appears to be independently associated with increased long-term mortality. This could lead to decreasing numbers of patients with a left dominant coronary artery system in older age groups.
  
  
  METHODS
  We assessed the type of coronary dominance in different age groups in postmortem angiograms that were routinely performed at autopsy between 1993 and 2007. Coronary dominance was determined by identifying the origin of the posterior descending artery and posterolateral branches on postmortem angiography. Age, gender, and cause of death were recorded from the autopsy database. The prevalence of left dominant, right dominant, and codominant systems was determined in three increasing age categories, with cutoffs based on tertiles.
  
  
  RESULTS
  A total 1620 coronary angiograms were assessed; 167 were excluded because it was not possible to determine coronary dominance. The median age of all patients was 71 years; 56% were male. Of all deaths, 40% were classified as cardiac. Regarding coronary dominance, 81.2% was right, 9.1% was left, and 9.7% was codominant. Overall, a decrease in prevalence of left and codominant coronary systems was observed with increasing age in the three age cohorts (≤ 63 years, 64-75 years, and ≥ 76 years) (P=.001 for overall comparison).
  
  
  CONCLUSIONS
  In this large autopsy cohort, the prevalence of a left dominant or codominant coronary system decreased with increasing age. These findings could relate to a slightly higher risk of mortality in case of left versus right coronary artery occlusion.
authors.affiliation: Faculty of medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Max
authors.initials: M
authors.lastname: Knaapen
authors.forename: Anna H
authors.initials: AH
authors.lastname: Koch
authors.forename: Charlotte
authors.initials: C
authors.lastname: Koch
authors.forename: Karel T
authors.initials: KT
authors.lastname: Koch
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Li
authors.forename: Peter C
authors.initials: PC
authors.lastname: van Rooij
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Ron J
authors.initials: RJ
authors.lastname: Peters
authors.forename: Allard C
authors.initials: AC
authors.lastname: van der Wal
authors.forename: Peter
authors.initials: P
authors.lastname: Damman
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000375:Aging; D001344:Autopsy; D002423:Cause of Death; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence