Clinical features of the development of myocardial infarction in depend of the variants topographic anatomy of the blood supply to the heart

Objective: to reveal the role of anatomical variants of coronary dominance in the localization of the infarct-dependent artery, the focus of necrosis and their interrelations. Materials and methods: The coronary angiography of 133 patients was retrospectively analyzed. Two groups were compared: patients with acute myocardial infarction and unstable angina. According to the coronary dominance of the heart, patients were divided into 3 subgroups: left-dominance (LD), right-dominance (RD) and balanced type. Results: patients with LD and myocardial infarction commonly occurred with significant stenosis of the left anterior descending artery (LAD), mainly in the proximal part. The right coronary artery (RCA) and the posterior lateral branch were infarction-dependent arteries for patients with RD. At the low localization of the focus of necrosis, the LAD is the infarct-dependent in patients with LD and RD of coronary dominance. However, the focus of necrosis of the anterior localization among patients with LD was significantly more common in LAD stenosis in the proximal and middle segments. Among patients with RD, significant stenosis of LAD in the proximal segment and the first obtuse marginal artery (OM1) were significant causes of myocardial infarction with the focus of necrosis in the anterior localization. Lateral myocardial infarction with LD was associated with significant stenosis of the first diagonal artery (D1). Whereas RD - with OM1 and LAD in the proximal segment. Stenosis of the right coronary artery often leads to the posterior MI. Posterior myocardial infarction wasn't identified among patients with LD type. Conclusion: we found differences in the arteries, the hemodynamically significant stenosis of which is reliably associated with the development of anterior, lateral and posterior myocardial infarction. These findings may indicate that among patients with different artery dominance there're differences in the blood supply of the anterior and lateral walls of the left ventricle (and not only of the posterior wall).

тип кровоснабжения миокарда, инфаркт-зависимые артерии, инфаркт миокарда, artery dominance, infarct dependent arteries, myocardial infarction

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