1165 Anomalous origin of the coronary artery arising from the opposite sinus: clinical impact and prognosis

Abstract

Abstract Anomalous origin of the coronary artery arising from the opposite sinus (ACAOS) is an infrequent congenital heart disease (CHD). Clinical presentation is variable and there is controversy over its treatment in relation to the affected coronary artery and the type of path. Our objective was to analyze the anatomical characteristics of ACAOS, their clinical impact and prognosis. We selected all patients with diagnosis or confirmation of diagnosis of ACAOS by computerized tomography (CT) in our center between 2014-2019, excluding complex CHD. Their baseline characteristics, tests for ischemia and follow-up were analyzed. 40 patients were diagnosed of ACAOS, and 26 had a simple coronary anomaly (mean age 54 years, 65% male). The most prevalent ACAOS was the right coronary artery (47%) followed by left main (27%). 42% had an inter-arterial path. Figure. Atherosclerosis on the ACAOS was similar to native arteries (p= >0,05). 11 of 18 (61%) patients with follow-up in our center had ischemia testing (23 tests). Only 22% were positive. 6 patients had a revascularization procedure (3 surgical, 3 percutaneous) and 83% included an intervention on the ACAOS. During follow up there were 13 major cardiovascular events (MACE). We observed a tendency to a higher number of MACE in patients with an interarterial path, although it was not statistically significant (p = 0,06). One patient died of a non-cardiac cause during follow-up. Only 4/18 patients (22%) had follow-up in the Adult CHD clinic. In our population ACAOS did not have statistically significant differences in the development of atherosclerosis compared to native arteries, tests for ischemia were mostly negative but there was a significant number of MACE so it is necessary to implement patient follow up in the specialized Adult CHD clinic. Baseline characteristics Hypertension 8 (35%) Type II diabetes mellitus 5 (22%) Dyslipidemia 9 (31%) Smoking history 10 (46%) Alcohol abuse 5 (22%) Previous symptoms 20 (80%) Ischemia on complementary tests 1 (8%) Diagnosis by coronariography 5/26 (19%) Diagnosis by computerised tomography 21/26 (81%) Anomalous artery atherosclerosis Moderate to severe atherosclerosis 10/26 (38,5%) 5/10 (50%) Native artery atherosclerosis Moderate to severe atherosclerosis 11/26 (42,3%) 6/11 (54,6%) Abstract 1165 Figure.