The coronary arteries represent the terminal branches of the ascending aorta and are responsible for the entire arterial supply of the myocardium. Their unique anatomical architecture—arising from the aortic sinuses and coursing over the surface of the heart before penetrating the myocardium—renders them susceptible to a wide spectrum of morphological variations. These variations range from minor differences in ostial position and vessel calibre to significant anomalies in number, origin, course, and termination.¹

The clinical importance of coronary arterial anatomy has grown considerably with advances in interventional cardiology and cardiac surgery. Coronary artery anomalies (CAAs) are identified in approximately 0.3–5.6% of patients undergoing coronary angiography, and their accurate delineation is essential before procedures such as percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and transcatheter aortic valve replacement (TAVR).²

Coronary dominance—defined by which artery gives rise to the posterior descending artery (PDA) and the atrioventricular nodal branch—determines the extent of myocardial territory at risk during acute coronary syndromes. Right dominance is the most common pattern globally, though its reported prevalence varies between 80% and 93% across different ethnic populations.^3,4

Myocardial bridging (MB), a phenomenon in which a segment of a coronary artery courses through the myocardium rather than the epicardial fat, has been associated with exercise-induced ischaemia, arrhythmias, and even sudden cardiac death. Its prevalence in cadaveric studies is substantially higher than in angiographic series, owing to the compression of intramural vessels that occurs only during systole.^5,6

The branching pattern of the left coronary artery (LCA) is particularly variable. While bifurcation into the left anterior descending (LAD) and left circumflex (LCx) arteries is the classic description, trifurcation with the addition of a ramus intermedius (RI) is present in a significant minority and creates an important variant relevant to percutaneous bifurcation treatment.^7,8

Despite the clinical significance of these variations, there remains a paucity of systematic cadaveric data from the Indian subcontinent. The majority of large-scale studies have been conducted using coronary computed tomographic angiography (CCTA) or conventional angiography in Western or East Asian populations, and findings may not be fully applicable to Indian patients owing to differences in body habitus, cardiac dimensions, and coronary artery disease risk profiles.^9,10

Regional cadaveric anatomical studies are therefore invaluable. Macroscopic dissection allows direct visualisation and measurement of coronary vessels without the limitations imposed by image resolution, cardiac motion artefact, or contrast medium distribution. Several Indian cadaveric studies have reported unique findings, including higher rates of certain branching patterns, that have not been replicated in imaging-based studies from other populations.^11,12