Marques-Antunes Miguel, van Oort Martijn J H, Oliveri Federico, Al Amri Ibtihal, Bingen Brian O, Cruz-Ferreira Rui, Wouter Jukema J, Montero-Cabezas Jose M
Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitario de Lisboa Central, Lisbon, Portugal.
Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
Catheter Cardiovasc Interv. 2025 Mar;105(4):951-958. doi: 10.1002/ccd.31414. Epub 2025 Jan 13.
The coronary atrial circulation is the network of vessels that supply blood to the atria, originating from the left circumflex and right coronary arteries. Current descriptions of this arterial system are based on anatomical studies with a limited number of patients, predominantly male. In addition, there is a lack of consensus its angiographic nomenclature.
This study aimed to evaluate the anatomical variations of coronary atrial branches (CAB) and investigate sex-related differences in their distribution.
Consecutive patients with ST-elevation myocardial infarction who underwent primary PCI at a tertiary center between 2004 and 2013 were included. Angiographic anatomy of all visible CAB on index coronary angiography was systematically evaluated following a stepwise method, including type of branch; coronary artery of origin; segment of origin, branch course, and atrial dominancy. Specific differences between both sexes were analyzed.
A total of 998 patients (age 61 ± 12, 79% male) were included. The sinus node artery was the dominant CAB in 916 (93%), originating in 37% from distal coronary segments. Different CAB anatomical patterns were identified in both sexes. Compared to females, males presented a higher prevalence of left-sided CAB (left circumflex CAB 459 [58%] vs. 96 [45%], p < 0.001; sigma-shaped CAB 267 [30%] vs. 39 [21%], p = 0.003) and of a left-balanced atrial circulation pattern-defined as the presence of at least two CAB originating from the LCx, with one of them being the dominant CAB-245 (31%) versus 45 (21%), p = 0.005.
This study provides a systematic approach to the angiographic evaluation of CAB. Sex-related phenotypical differences of CAB distribution were found, with males presenting a higher presence of left-sided CAB and a left-balanced atrial circulation pattern.
冠状心房循环是为心房供血的血管网络，起源于左旋支和右冠状动脉。目前对该动脉系统的描述基于对数量有限的患者（主要为男性）进行的解剖学研究。此外，其血管造影命名法缺乏共识。
本研究旨在评估冠状心房分支（CAB）的解剖变异，并研究其分布的性别差异。
纳入2004年至2013年在一家三级中心接受直接经皮冠状动脉介入治疗（PCI）的连续性ST段抬高型心肌梗死患者。采用逐步方法对首次冠状动脉造影上所有可见的CAB的血管造影解剖结构进行系统评估，包括分支类型、起源冠状动脉、起源节段、分支走行和心房优势。分析两性之间的具体差异。
共纳入998例患者（年龄61±12岁，79%为男性）。窦房结动脉是916例（93%）患者中的主要CAB，37%起源于冠状动脉远端节段。在两性中均发现了不同的CAB解剖模式。与女性相比，男性左侧CAB的发生率更高（左旋支CAB 459例[58%]对96例[45%]，p<0.001；σ形CAB 267例[30%]对39例[21%]，p=0.003），以及左平衡心房循环模式（定义为至少有两个CAB起源于左旋支，其中一个为主要CAB）的发生率更高，分别为245例（31%）对45例（21%），p=0.005。
本研究为CAB的血管造影评估提供了一种系统方法。发现了CAB分布的性别相关表型差异，男性左侧CAB和左平衡心房循环模式的发生率更高。
