Presence and characteristics of coronary artery fistulas among patients undergoing coronary angiography

Abstract

Background Coronary artery fistula is defined as a connection between one or more coronary artery and a heart chamber. aims The aim of the study was to determine the overall incidence of coronary artery fistulas in Polish patients undergoing diagnostic coronary artery angiography as well as the frequency of particular origin and draining sites. methods The data were obtained from the Polish National Registry of Invasive Cardiology Procedures among patients hospitalized between January 1, 2014 and December 31, 2016 in invasive cardiology departments in Poland. results The study included 298 558 patients. A coronary artery fistula was present in 261 patients (0.087%). There were 131 women (50.19%) and 130 men (49.81%). The most frequent origin of a coronary artery fistula was the left anterior descending artery (167 cases, 59.22%). The pulmonary artery was the most frequent drainage site for fistulas originating from the left anterior descending artery and the right coronary artery (84 cases, 50.30% and 25 cases, 31.65%, respectively). Fistulas originating from the circumflex artery most frequently drained into another artery (10 cases, 27.78%). conclusions The left anterior descending coronary artery was the origin site for more than half of all detected coronary artery fistulas. The pulmonary artery was the most frequent origin and drainage site for coronary artery fistulas.

Coronary artery fistula: an innocent bystander or harmful company?

“…Lim et al 10 demonstrated that there is a relation between CAFs, in particular in coronary to bronchial and pulmonary fistulas, and lung parenchymal abnormalities such as bronchiectasis or hypoplasia of the pulmonary vasculature. These findings could, in part, explain the high incidence of chronic obstructive disease in association with CAFs reported by Podolec et al 7 In conclusion, the relevance of the study by Podolec et al 7 lies in the amount of data described, and it provides useful information on prevalence and anatomy of CAFs. However, as all the studies on CAFs, it is a retrospective analysis, which cannot provide information on clinical significance and prognostic impact of CAFs.…”

“…For commercial use, please contact the journal office at kardiologiapolska@ptkardio.pl. Indications for coronary angiography in the study of Podolec et al 7 were stable coronary artery disease, acute coronary syndromes, cardiac arrest, congenital heart defects, and other indications. They found a higher prevalence of CAFs in the subgroup of patients submitted to coronary angiography for other indications.…”

“…to 55% of cases, and is followed by the left anterior descending artery, accounting for about 35% to 40% of cases, and the left circumflex artery, accounting for 5% to 20% cases. 8,9 These literature data were generally derived from a smaller number of patients, while Podolec et al 7 analyzed a larger population in a relatively short period, thus providing more robust epidemiologic data.…”

“…In this large registry, Podolec et al 7 analyzed data from coronary angiography. Recently, it has been demonstrated that the prevalence of CAFs seen at coronary computed tomography is 0.9%, which is higher than the previously reported prevalence of 0.002% to 0.3% at coronary angiography.…”

“…The acquired forms may be further divided into iatrogenic (during percutaneous coronary intervention, cardiac surgery, myocardial biopsy, septal myectomy), traumatic, or related to a disease (such as myocardial infarction, Takayasu arteritis, cardiomyopathies). 5,6 The study by Podolec et al, 7 published in this issue of Kardiologia Polska (Kardiol Pol, Polish Heart Journal), is a retrospective study that aims to determine the prevalence of coronary artery fistulas (CAFs) in Poland using coronary angiography. Data were obtained from the Polish National Registry of Procedures of Invasive Cardiology (Polish, Ogólnopolski Rejestr Procedur Kardiologii Inwazyjnej).…”