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Anatomic characteristics and outcome of adults with coronary arteries arising from an anomalous location detected with coronary computed tomography angiography

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Abstract

We sought to determine the anatomic characteristics of coronary arteries arising from an anomalous location (CAAL) detected on coronary computed tomography angiography (CTA) and assess the impact of high-risk anatomic characteristics on patient management and outcomes. We reviewed 9,774 consecutive CTA studies performed in adults between 2008–2013 and identified 114 with CAAL. CTA examinations were analysed to determine CAAL type, CAAL course (pre-pulmonary, interarterial, septal or retroaortic) and whether additional high-risk anatomic characteristics were present (luminal compression, intramural course, slit-like ostium and acute takeoff angle). Patients were contacted at mean 27.1-months to determine safety outcomes. The prevalence of CAAL was 1.14 % (114 of 9,974), with 36 (32 %) having anomalous right coronary artery from left coronary sinus, 71 (62 %) having anomalous left coronary artery from right coronary sinus and 7 (6 %) having a coronary artery arising outside coronary sinuses. Fifty-six patients (49 %) had ≥1 high-risk anatomic characteristic on CTA. Ten patients (9 %) underwent surgical intervention. Patients with high-risk anatomic features more frequently underwent functional testing (46 vs. 12 %, P = 0.01) and surgical intervention (14 vs. 3 %; P = 0.04) compared to patients without high-risk features. Patients undergoing surgery were more likely to have obstructive coronary disease on CTA than patients managed conservatively (50 vs. 13 %, P = 0.01). There was no cardiac death or ACS at follow-up (100 % complete). High-risk anatomic features on CTA in patients with CAAL more frequently lead to surgical management. Regardless of CAAL type, presence of high-risk anatomic characteristics or management strategy, the medium-term outcome of adults with CAAL is excellent.

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Abbreviations

CTA:

Coronary computed tomography angiography

CAAL:

Coronary artery arising from anomalous location

RCA:

Right coronary artery

LAD:

Left anterior descending coronary artery

LCx:

Left circumflex coronary artery

LMCA:

Left main coronary artery

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Acknowledgments

Dr Arthur Nasis currently holds research scholarships from the National Health and Medical Research Council (NHMRC), the National Heart Foundation of Australia and the Monash Health Senior Medical Staff Association.

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Authors and Affiliations

  1. Monash Cardiovascular Research Centre, MonashHEART, Monash Health, 246 Clayton Road, Clayton, 3168, Australia

    Arthur Nasis, Colin Machado, James D. Cameron, John M. Troupis, Ian T. Meredith & Sujith K. Seneviratne

  2. Department of Medicine (MMC), Monash University, Melbourne, Australia

    Arthur Nasis, Colin Machado, James D. Cameron, John M. Troupis, Ian T. Meredith & Sujith K. Seneviratne

  3. Department of Diagnostic Imaging, Monash Health, Melbourne, Australia

    John M. Troupis

  4. Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Radiation Sciences, Monash University, Melbourne, Australia

    John M. Troupis

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  1. Arthur Nasis
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  2. Colin Machado
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Correspondence to Arthur Nasis.

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Nasis, A., Machado, C., Cameron, J.D. et al. Anatomic characteristics and outcome of adults with coronary arteries arising from an anomalous location detected with coronary computed tomography angiography. Int J Cardiovasc Imaging 31, 181–191 (2015). https://doi.org/10.1007/s10554-014-0535-4

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  • DOI: https://doi.org/10.1007/s10554-014-0535-4

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