Prevalence and characteristics of coronary artery anomalies detected by coronary computed tomography angiography in 5 634 consecutive patients in a single centre in Switzerland.

C Gräni,Ta Fuchs,J Stehli,F Mikulicic,O Gaemperli,Dc Benz,Rr Buechel,Ap Pazhenkottil,J Vontobel,C Schmied,Pa Kaufmann,Of Clerc,M Possner

doi:10.4414/smw.2016.14294

Abstract

Coronary computed tomography angiography (CCTA) allows three-dimensional visualisation of the origin, course and ending of the coronary vessels with high spatial resolution, yielding an accurate depiction of coronary artery anomalies (CAAs). This study sought to determine the prevalence, incidence and characteristics of CAAs detected with CCTA in a single centre in Switzerland. CAAs were retrospectively identified in 5 634 consecutive patients referred for CCTA between March 2007 and July 2015. Single coronary arteries, Bland-White-Garland syndrome, anomalous coronary arteries originating from the opposite site of the sinus of Valsalva (ACAOS) with an interarterial course and coronary artery fistulas were classified as potentially malignant CAAs. We identified 145 patients with CAAs, resulting in an overall prevalence of 2.6% and cumulative incidence of 2.1% in all patients referred for CCTA in the observation period. Forty-nine (33.8%) patients showed malignant CAAs including 1 (0.7%) patient with Bland-White-Garland syndrome, 7 (4.8%) with single coronary arteries, 36 (24.8%) with ACAOS and an interarterial course, and 5 (3.5%) with coronary artery fistulas. The remaining 96 (66.2%) patients were classified as having benign variants. The prevalence of CAA detected by CCTA is not negligible. Because of its noninvasive nature, relatively low cost and low radiation exposure, a further increase in the utilisation of CCTA may be expected, which may consequently be paralleled by an increasing absolute number of incidentally detected CAAs. Hence, awareness of the main issues and possible management strategies regarding CAAs is of importance for every treating physician.

Highlights

The incidence of coronary artery anomalies (CAAs) in the general population is reported to be 0.3–5.6% [1, 2]
We identified 145 patients with CAAs, resulting in an overall prevalence of 2.6% and cumulative incidence of 2.1% in all patients referred for Coronary computed tomography angiography (CCTA) in the observation period
Because of its noninvasive nature, relatively low cost and low radiation exposure, a further increase in the utilisation of CCTA may be expected, which may be paralleled by an increasing absolute number of incidentally detected CAAs

Summary

Introduction

The incidence of coronary artery anomalies (CAAs) in the general population is reported to be 0.3–5.6% [1, 2]. Coronary computed tomography angiography (CCTA) is considered the primary imaging modality to detect and characterise the anatomy of a CAA. CCTA has seen substantial technical advances over the last decade, with regard to spatial resolution and an impressive reduction in radiation dose exposure [6]. These developments were paralleled by a growing use of CCTA in clinical routine and increasing importance for noninvasive assessment of suspected coronary artery disease (CAD) in patients with low-to-intermediate pretest probability [7]. It may be expected that the incidental detection of CAAs will see a further increase, and referring

Methods

Results

Conclusion