Coronary artery anomalies: Unusually high incidence of anomalies with a malignant course in an Asian population

Abstract

Objectives:Coronary artery anomalies are uncommon, but important cardiac malformations, representing the second commonest cause of death in young athletes.Methods:We utilized computerized tomographic angiography to screen and precisely delineate coronary artery anomalies in patients with minimal cardiac symptoms.Results:During 3.5-year period, we performed 2888 computerized tomographic angiographies. A total of 33 (1.1%; 95% confidence interval = 0.7–1.5) cases of coronary artery anomalies were identified (mean age = 44 ± 13.5 (15–70) years). In total, 23 patients (mean age = 43 years) had malignant coronary artery anomalies with an inter-arterial course of the aberrant vessel: of which 3 had left main coronary artery arising from right coronary sinus and 20 right coronary artery from left sinus; 19 patients were of Asian and 14 were of Arab origins. Of interest, 21 out of 33 patients had chest pain, 5 had palpitations, and 2 had breathlessness. There were no examples of sudden cardiac death. All patients received appropriate advice regarding physical exertion and medical management, and remained well for 2–5 years of follow-up. Of 33 patients, 4 had significant symptomatic coronary artery disease requiring intervention: 1 percutaneous coronary intervention and 3 coronary artery bypass graft surgery.Conclusion:There is a relatively high incidence of coronary artery anomalies with malignant course in Asians. The vast majority were managed conservatively.

Coronary Artery Anomalies by Multidetector Computed Tomography

“…Malignant course of the anomalous coronary artery located inbetween the aorta and the pulmonary arterial trunk with an increased risk for sudden death. The current study showed an incidence of this anomaly in 0.9% of the studied patients, this was in line with Alkhulaifi et al, 2017 [13] who reported nearly the same percentage (0.8%). In the current study, one case was reported with RCA splittage into two arteries just after originating from its ostium in the right sinus of Valsalva (0.1%) and this is similar to the results of a study of Kosar et al, 2009 [14].…”

Echocardiographic Screening of Anomalous Origin of Coronary Arteries in Athletes with a Focus on High Take-Off

“…Despite this extremely high feasibility, the detection rate of AAOCA by echocardiography seems to be suboptimal. Indeed, the known estimates of AAOCA by CCTA, CMR, and autoptic studies range from 0.3% to 1.8% [ 4 , 7 , 23 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ], while echocardiographic studies reported significant lower incidences, ranging from 0% [ 15 , 24 , 30 ] to 0.09% [ 20 ] and up to 0.76% [ 23 ]. However, echocardiographic studies with low incidences of AAOCAs were either retrospective [ 15 ] or used echocardiography in a fast-echo approach in the context of preparticipation evaluation of athletes [ 24 , 31 ].…”

“…In recent years, the interest in the noninvasive evaluation of anomalous aortic origin of coronary arteries (AAOCA) has increased and multiple imaging, surgical and autoptic studies have been published [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. AAOCAs are rare defects with estimates varying from 0.2% to 2.2% in autopsy series [ 23 ] and from 0.3% to 1.8% in Coronary Computed Tomography Angiography (CCTA) studies [ 4 , 7 , 24 ]. Despite being rare, AAOCAs have been recognized as important lesions with significant potential morbidity and mortality, since they represent the second cause of sudden cardiac death (SCD) in athletes [ 1 , 2 ].…”

“…Indeed, according to recent studies, AAOCAs account for 15.7% to 19% of all causes of SCD in young athletes [ 1 , 2 , 3 ]. Echocardiography is the first imaging modality to screen and diagnose coronary anomalies [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. Recommendations for multimodality imaging of congenital coronary artery anomalies have been recently published (March 2020) [ 26 ], supporting the use of echocardiography as first-line imaging modality to detect AAOCAs.…”

Coronary artery anomalies in patients with zero calcium score: A new evidence supports the 2016-NICE guidance

“…Alkhulaifi et al reported that Asian and Middle Eastern population have a relatively higher incidence of malignant CAA, with passage of the major aberrant trunk between the two great vessels [ 33 ]. This could be explained by higher relative marriage in these countries which facilitates the transmission of any genetic or genetic-related disorder.…”