Abstract
BackgroundMost reported cases of right anomalous coronary artery from the opposite sinus (R-ACAOS) have benign clinical outcomes. However, patients with left ACAOS (L-ACAOS) and some of the patients with R-ACAOS are more at risk for arrhythmias and sudden cardiac death, which remains a major concern. Here we report the prevalence and anatomical features of ACAOS patients. Moreover, we explore the high-risk morphological signs and evaluate their mid-term prognostic value in R-ACAOS patients without surgical intervention.MethodsData from coronary computed tomography angiography (CTA) of 30,593 patients, pertaining to a single center over 5 consecutive years, were retrospectively analyzed. The image analysis included stenosis severity ranking and high-risk anatomy evaluation, based on the commercially available image post-processing software OsirX. Patients with R-ACAOS and without evidence of coronary atherosclerosis (CAD) were followed-up, with recording of the cardiovascular clinical events. Cox regression analysis was performed to identify the potential anatomical risk factors of cardiovascular clinical events for non-CAD R-ACAOS patients, using R project.ResultsThe prevalence of ACAOS in the study population was 0.69% (211/30593). Significant differences were found between patients with mild (< 50%) and severe (> 50%) stenosis, in terms of height-to-weight ratio (HW ratio), take-off angle, and proximal stenosis length. A total of 54 cardiovascular clinical events were observed among 108 non-CAD R-ACAOS patients and an average follow-up of 27.8 ± 18.7 months. Among those patients’ anatomical features, stenosis severity was the main risk factor for cardiovascular clinical events during the mid-term follow-up, with a risk ratio of 4.14 (95% CI: 1.78 to 9.63, P < 0.001).ConclusionsAmong patients referred to coronary CTA, the overall incidence of ACAOS was 0.69%. For patients with R-ACAOS, severe stenosis was the independent risk factor of adverse clinical events in the mid-term follow-up, and positive clinical intervention might be needed to help them avoid the malignant clinical events.
Highlights
Most reported cases of right anomalous coronary artery from the opposite sinus (R-Anomalous coronary artery from the opposite sinus (ACAOS)) have benign clinical outcomes
Among patients referred to coronary computed tomography angiography (CTA), the overall incidence of ACAOS was 0.69%
ACAOS patients were divided into 2 groups, coronary artery disease (CAD) (n = 82, age: 64.5 ± 12.2) and non-CAD (n = 129, age: 55.3 ± 13.5), according to the presence of atherosclerosis plaques
Summary
Most reported cases of right anomalous coronary artery from the opposite sinus (R-ACAOS) have benign clinical outcomes. Anomalous coronary artery from the opposite sinus (ACAOS) has long been recognized as a common type of congenital coronary artery malformation [1] with a prevalence between 0.14 and 1.7% This anomaly has been considered as relatively “friendly,” compared with other congenital diseases, epidemiological studies have identified left ACAOS (L-ACAOS) and some of the right ACAOS (R-ACAOS) as a major factor of sudden cardiac death (SCD) in young adults [2], especially competitive athletes [3], and a number of patients with this anatomical variation present similar symptoms to those with coronary artery disease (CAD). Other recommended methods for plaque characterization and observation of coronary ostium anomalies include transesophageal echocardiography (TEE) [8] and intravascular ultrasonography [9] These are inevitably limited by a relatively lower capacity for anatomical description and dependence on operating physicians. Magnetic resonance imaging is proposed when physiologic details are required, it is inferior to coronary CTA for coronary artery morphological evaluation [8]
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