The distribution and prognosis of anomalous coronary arteries identified by cardiovascular magnetic resonance: 15 year experience from two tertiary centres

Abstract

BackgroundAberrant coronary arteries represent a diverse group of congenital disorders. Post-mortem studies reveal a high risk of exercise-related sudden cardiac death in those with an anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS) with an inter-arterial course. There is little documentation of lifetime history and long-term follow-up of patients with coronary artery anomalies.MethodsPatients with anomalous coronary arteries undergoing cardiovascular magnetic resonance over a 15-year period were identified and classified by anatomy and course. Medical records were reviewed for major adverse cardiovascular events (MACE). Revascularisation or myocardial infarction counted only if occurring in the distribution of the anomalous artery.ResultsConsecutive patients with coronary artery anomalies were retrospectively identified (n = 172). Median follow-up time was 4.3 years (IQR 2.5–7.8, maximum 15.6). 116 patients had ACAOS of which 64 (55%) had an inter-arterial course (IAC) and 52 (45%) did not. During follow up 110 ACAOS patients were alive, 5 died and 1 lost to follow-up.ACAOS patients experienced 58 MACE events (5 cardiovascular deaths, 5 PCI, 24 CABG and 24 had myocardial infarction). 47 MACE events occurred in ACAOS with IAC and 11 in those without (p < 0.0001), the statistical difference driven by surgical revascularisation and myocardial infarction.ConclusionsIn life, patients with an anomalous coronary artery originating from the opposite sinus of Valsalva taking an IAC have higher rates of both myocardial infarction and surgical revascularisation during long-term follow up, compared to those without IAC.

Challenges of Anomalous Coronary Artery Intervention: Case Series and a Review

“…Stenting of the proximal RCA led to resolution of symptoms and normalization of CMR finding. Ripley et al demonstrated the utility of cardiovascular magnetic resonance in their study to detect 172 CAAs over a 15 year period [33]. All of the detected cases were able to be anatomically classified based on the CMR images.…”

Nonfatal Myocardial Infarction in Previously Healthy Adolescent - A 1-Year Follow-Up

“…It is speculated that infarction also can result from coronary hypoperfusion in asphyxiated infants [8]. David P Riple reported after a long-term follow-up, AMI in the neonate with an anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS), 24 of those had myocardial infarction with a 4.3% mortality rate over 4.6 years [9]. Krasuski also demonstrated a substantially higher mortality ACAOS rate of 44% over a mean 9.2 year follow-up [10].…”

Anomalous coronary arteries: What we know and what we do not know

“…Contemporary imaging studies have demonstrated a prevalence of 1.3% in the largest direct angiographic series (n = 126,595), from 1960 to 1988 at the Cleveland Clinic, 1 2.33% in a recent consecutive CT coronary angiographic series of 2572 patients from Greece, 2 and 0.3% in 59,844 cardiac magnetic resonance scans from England. 3 Furthermore, not all of the anomalies identified in those studies were of clinical relevance to the patients. Some, such as a high takeoff of a coronary (at or above the sinotubular junction) without an intramural course, an anomalous circumflex coronary originating from the right coronary sinus and coursing posterior to the aorta and separate origins of the circumflex and left anterior descending (LAD) coronary arteries from the left sinus of Valsalva, are typically of no clinical consequence to the patient, although they may be of technical interest to an angiographer.…”

“…for 116 patients with ACAOS. 3 There were 5 deaths, 4 from myocardial infarction, all of which were attributable to CAD and 1 from CHF and CAD. In total, there were 24 myocardial infarctions in the territory of the anomalous coronary artery and all infarctions were related to atherosclerotic plaque.…”