Anomalous Origin Of The Right Coronary Artery With Interarterial Course: Red Flag Or Innocent Bystander?

F Albuquerque,P De Araújo Gonçalves,H Marques,A M Ferreira,P Freitas,P M Lopes,M Gonçalves,H Dores,N Cardim

doi:10.1016/j.jcct.2021.06.182

F Albuquerque, P De Araújo Gonçalves + Show 7 more

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https://doi.org/10.1016/j.jcct.2021.06.182

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Abstract

Introduction: Anomalous origin of the right coronary artery from the opposite sinus (right-ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomographic angiography (CCTA) has led to increasing recognition of this condition, even among healthy individuals. Our study sought to examine the prevalence, anatomical characteristics and outcomes of right ACAOS with IAC in patients undergoing CCTA for suspected CAD.

Highlights

The prevalence of anomalous origin of the coronary artery from the opposite sinus (ACAOS) is low, around 1% in the general population. [1, 2, 3] ACAOS with interarterial course (IAC) is relevant given its association with sudden cardiac death (SCD), mostly in young patients undergoing high intensity physical activity. [4, 5, 6, 7] This association derives mostly from retrospective cohort analysis of autopsy reports for SCD. [8] In the cases where it is the only cardiac anomaly depicted in the autopsy it is not difficult to consider ACAOS as the most probable cause
Among 10928 patients referred for coronary computed tomography angiography (CCTA) during the study period, of whom n = 9289 for the evaluation of possible coronary artery disease (CAD), we identified 28 patients with right-ACAOS with IAC, resulting in an overall prevalence of 0.26%
The main findings of our study can be summarized as follows: (1) among patients referred for CCTA for possible CAD, the prevalence of right ACAOS with ICA was 0.26%; (2) there were no major clinical events over a median follow-up of 45.5 months and only one patient was submitted to cardiac surgery, even considering that the majority of patients would have been classified as high-risk according to proposed anatomical findings on CCTA; (3) There was no association between high-risk anatomic features and the presence of an intramural segment

Summary

Introduction

The prevalence of anomalous origin of the coronary artery from the opposite sinus (ACAOS) is low, around 1% in the general population. [1, 2, 3] ACAOS with IAC (i.e., coronary course between the aorta and the pulmonary artery) is relevant given its association with sudden cardiac death (SCD), mostly in young patients undergoing high intensity physical activity. [4, 5, 6, 7] This association derives mostly from retrospective cohort analysis of autopsy reports for SCD. [8] In the cases where it is the only cardiac anomaly depicted in the autopsy it is not difficult to consider ACAOS as the most probable cause. [1, 2, 3] ACAOS with IAC (i.e., coronary course between the aorta and the pulmonary artery) is relevant given its association with sudden cardiac death (SCD), mostly in young patients undergoing high intensity physical activity. Several authors reported a much lower risk of SCD attributed to ACAOS when compared to that reported in autopsy series. [11, 12] With its increasing use, in the setting of suspected coronary artery disease (CAD) in patients with a low-to-intermediate cardiovascular risk, higher absolute numbers of apparently healthy individuals with incidentally diagnosed ACAOS are to be expected. The objective of our study was to evaluate the prevalence, anatomical characteristics, management strategies and long-term outcomes of patients with right-ACAOS with IAC in patients undergoing CCTA for suspected CAD

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