Background
Anomalous origin of the right coronary artery (ARCA) represents the most frequent form of abnormal coronary origin and may potentially increase the risk for sudden cardiac death. Evaluation of ARCA in adult patients referred for invasive coronary angiograms (ICA) is difficult, and clinical impact is unknown. Quantitative flow reserve (QFR) is an available method able to virtually calculate fractional flow reserve using 3-dimensional quantitative coronary angiography (3D-QCA) based on ICA.
Objectives
To evaluate the feasibility of QFR analysis in patients with ARCA and its clinical impact.
Methods
Using the registry of proximal anomalous connections of coronary arteries (ANOCOR registry), a multicentric observational registry including 472 adult patients with ANOCOR between 2010 and 2013, we retrospectively performed QFR analysis from ICA and evaluated the rate of death, myocardial infarction, unplanned revascularization and hospitalization in cardiology at 5 years.
Results
Among 128 patients with ARCA, 41 (32%) could have QFR analysis with median clinical follow-up of 8.3 years. The mean QFR value was 0.90±0.10, and 3D-QCA analysis showed preserved lumen area despite the elliptical shape of the proximal part of the ARCA which in the worst cases appeared on ICA as a significant narrowing. The event rate was 14.6% (n=6), including three deaths (one due to cancer, one due to stroke, and one cause remains unknown), two unplanned revascularizations, and one hospitalization for heart failure at 5 years. No myocardial infarction was reported.
Conclusions
QFR analysis of ARCA is feasible and non-significant QFR values are associated with good clinical outcome at 5 years. QFR of ARCA could be the evaluation of choice to help in clinical decision-making during ICA, when applicable.
Background
With the emergence of coronary computed tomography angiography (CCTA), ANOmalous connections of CORonary arteries (ANOCOR) are more frequently diagnosed than previously reported. CT-derived Fractional Flow Reserve (FFRCT) is a non-invasive functional test providing anatomical and functional evaluation of the overall coronary tree. These unique features could help for the management of patients with ANOCOR.
Objective
We aimed to retrospectively evaluate the clinical impact of FFRCT analysis in the ANOCOR registry population with 3 year-follow-up.
Method
The ANOCOR registry included adult patients with ANOCOR detected during invasive coronary angiogram or CCTA performed between January 2010 and January 2013. Among 472 patients included, 105 patients had a cardiac CT during the inclusion period.
Results
We retrospectively performed FFR-CT and obtained successful analyses in 54 patients of 60±13 years with a complete 3-year clinical follow-up. Thirty-six (67%) patients had conservative treatment and 18 (33%) patients had coronary revascularization after the CCTA. FFRCT analysis showed that ANOCOR course slightly reduces the mean FFRCT value of 1 at the ostium to 0.90±0.10 downstream the abnormal course and had a distal vessel mean FFRCT value 0.82±0.11. No statistical difference of FFRCT values were observed between ANOCOR at risk and non at risk and between conservative and revascularization groups. At 3 years of follow-up, only one patient had unplanned revascularizations of ANOCOR vessel in the conservative strategy group.
Conclusion
We observed favorable FFRCT values of ANOCOR and non ANOCR vessels. Patients treated conservatively and revascularized had excellent clinical outcome at 3 years of follow up.
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