Anomalous origin of the coronary artery from the wrong coronary sinus evaluated with computed tomography: “High-risk” anatomy and its clinical relevance
- 526 Downloads
The aim of the study was to assess coronary arteries arising from the wrong coronary sinus, including CT-evaluated high-risk anatomic features, clinical symptoms and cardiac events during follow-up.
A total of 7,115 patients scheduled for 64-slice or dual-source cardiac CT were screened for the presence of isolated anomalous origin of the coronary artery from the wrong coronary sinus.
Anomalous origin of the coronary artery was found in 54 (0.76 %) patients (29 men, 25 women, mean age 60.9 ± 11.6 years). Sixteen (30 %) patients with abnormal right coronary origin (ARCA) more commonly had a slit-like orifice (15 vs. 3; p < 0.001), intramural course (15 vs. 3; p < 0.001) and interarterial course (11 vs. 0; p < 0.001) than 22 (41 %) and 13 (24 %) individuals with abnormal circumflex artery (ALCx) and left coronary artery (ALCA) origin, respectively. Patients with ALCA presented less frequently with chest pain than subjects with ARCA and ALCx (25 vs. 3; p = 0.03). Patients with ARCA tended to show higher occurrence of cardiac events in the follow-up than individuals with ALCA and ALCx (5 vs. 4; p = NS).
High-risk anatomy features are most common in patients with ARCA and these patients also have higher prevalence of chest pain and cardiac events in the follow-up than individuals with ALCA and ALCx.
• Multislice computed tomography enables detection and evaluation of the coronary artery anomalies.
• Anomalous anatomy of the coronary artery potentially influences the prevalence of adverse events.
• Adverse events tend to be most common in anomalous right coronary arteries.
KeywordsMultislice computed tomography Coronary vessel anomalies Follow-up studies Cardiovascular abnormalities Anatomy
Anomalous origin of the circumflex artery from the right coronary artery sinus
Anomalous origin of the right coronary artery from the left coronary artery sinus
anomalous origin of the left coronary artery from the right coronary artery sinus
Coronary artery bypass grafting
Invasive coronary angiography
Percutaneous coronary interventions
The scientific guarantor of this publication is Dr Małgorzata Urbańczyk-Zawadzka, Head of the Department of Radiology and Diagnostic Imaging, John Paul II Hospital, Krakow, Poland. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval and written informed consent were not required because this is a primarily retrospective study. In the follow-up patients were contacted and asked if any cardiac events had occurred. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.
- 11.Cademartiri F, Casolo G, Midiri M (2008) Clinical applications of cardiac CT. Springer-Verlag, BerlinGoogle Scholar
- 12.Kaiser C, Bremerich J, Haller S, Brunner-La Rocca HP, Bongartz G, Pfisterer M, Buser P (2005) Limited diagnostic yield of non-invasive coronary angiography by 16-slice multi-detector spiral computed tomography in routine patients referred for evaluation of coronary artery disease. Eur Heart J 26:1987–1992PubMedCrossRefGoogle Scholar
- 16.Warnes CA, Williams RG, Bashore TM et al (2008) ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). Circulation 118:2395–2451PubMedCrossRefGoogle Scholar
- 22.Bischoff B, Hein F, Meyer T, Krebs M, Hadamitzky M, Martinoff S, Schömig A, Hausleiter J (2010) Comparison of sequential and helical scanning for radiation dose and image quality: results of the Prospective Multicenter Study on Radiation Dose Estimates of Cardiac CT Angiography (PROTECTION) I Study. AJR Am J Roentgenol 194:1495–1499PubMedCrossRefGoogle Scholar