Abstract
Background and Objectives: Acquired coronary fistulas (ACFs) are rare coronary artery abnormalities in patients with chronic total occlusion (CTO). It has been found after revascularization, and it may cause fluster during the CTO percutaneous coronary intervention (CTO PCI). How to distinguish between ACFs and coronary perforation (CP) is very important for CTO operators. Chronic total occlusion reopening may reveal the microchannel of the adventitial vascular layers. Some of ACFs have been seen after revascularization. This study aimed to investigate the characteristics of ACFs after successful CTO PCI.Methods: The clinical and procedural characteristics, medical history, and findings in electrocardiography (ECG), echocardiography, and coronary angiography were collected from 2,169 consecutive patients undergoing CTO PCI between January 2018 and December 2019 and analyzed retrospectively.Results: About 1,844 (85.02%) underwent successful CTO PCI with complete revascularization. Acquired coronary fistulas were found in 49 patients (2.66%): the majority of patients with ACFs were men (81.63 vs. 60.78%; p = 0.016) and younger (62.8 vs. 66.69 years; p = 0.003), and had a history of myocardial infarction (MI) or Q-wave (69.39 vs. 54.21%; p = 0.035); 38 (77.55%) patients had multiple fistulas (â„3), and ACFs affected multiple branches of the CTO vessel (â„3) in 29 (59.18%) patients. None had pericardial effusion, tamponade, and hemodynamic abnormality before or after PCI.Conclusion: Acquired coronary fistulas after successful CTO PCI are mainly present in young and male patients with a history of MI, and they often involve multiple fistulas and distal CTO vessels.
Highlights
Coronary fistulas were first described as congenital and abnormal vascular connections between coronary arteries and cardiac chambers or with other vessels, but other factors may cause coronary fistulas [1], including trauma, surgery, severe coronary atherosclerosis, and myocardial infarction (MI)
By New York Heart Association (NYHA) classification, seven patients were classified as class I, 26 as class II, 11 as class III, and five as class IV
Smoking is a risk factor for coronary artery disease (CHD) and is more common among patients with acquired coronary fistulas (ACFs) originating from left anterior descending (LAD) and right coronary artery (RCA), which could be ascribed to the smaller sample size or lower incidence in left circumflex coronary artery (LCX)
Summary
Coronary fistulas were first described as congenital and abnormal vascular connections between coronary arteries and cardiac chambers or with other vessels, but other factors may cause coronary fistulas [1], including trauma, surgery, severe coronary atherosclerosis, and myocardial infarction (MI). Myocardial infarction is a common cause of acquired coronary fistulas (ACFs) [2, 3], and ACFs secondary to MI are usually harmless, common in patients with chronic total occlusion (CTO), and hard to identify before complete revascularization because of insufficient collateral filling. It is important to distinguish ACF from coronary perforation (CP), a rare but potentially serious complication in PCI, which can lead to pericardial effusion and tamponade, often necessitating medical treatment and even emergency pericardiocentesis or cardiac surgery [4]. Acquired coronary fistulas (ACFs) are rare coronary artery abnormalities in patients with chronic total occlusion (CTO). It has been found after revascularization, and it may cause fluster during the CTO percutaneous coronary intervention (CTO PCI). This study aimed to investigate the characteristics of ACFs after successful CTO PCI
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