Global prevalence and clinical implications of coronary artery dominance: A meta-analysis

BACKGROUND: Coronary artery dominance (CD) influences myocardial perfusion, collateral vessel development, and cardiovascular outcomes. However, reported prevalence estimates vary across populations and study methodologies. This systematic review and meta-analysis aimed to estimate the global prevalence of CD variations, and evaluate their association with coronary artery disease (CAD). METHODS: Following the PRISMA 2020 guidelines, a systematic review of MEDLINE/PubMed, Scopus, and Web of Science was conducted to identify studies reporting the prevalence of CD. Pooled prevalence estimates and odds ratios (ORs) were calculated using random-effects models, along with subgroup and meta-regression analyses. RESULTS: Thirty-nine studies (78,591 unique patients) with 40 analytical cohorts were included. Right-sided CD (RCD) was the most prevalent variant globally at 82.01% (95% CI: 79.68-84.22), followed by left-sided (LCD) at 10.39% (95% CI: 9.31-11.52) and balanced CD (BCD) at 6.40% (95% CI: 4.67-8.37). The prevalence of LCD varied significantly across geographic regions. RCD varied by study methodology, with higher estimates reported in computed tomography coronary angiography studies than in cadaveric investigations. In the secondary analysis, BCD was associated with lower odds of CAD compared with RCD (OR 0.88, 95% CI: 0.80-0.97; p = 0.013). CONCLUSIONS: RCD is the predominant coronary circulation pattern, although its reported prevalence varies significantly according to study methodology. BCD was associated with lower odds of CAD compared with RCD; however, this finding is based on a limited number of studies and should be interpreted with caution. Recognition of CD patterns may assist cardiovascular imaging interpretation, cardiovascular risk assessment, and procedural planning.