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Multicenter Study
. 2014 May 20;16(1):34.
doi: 10.1186/1532-429X-16-34.

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

David P Ripley, Ansuman Saha, Albert Teis, Akhlaque Uddin, Petra Bijsterveld, Ananth Kidambi, Adam K McDiarmid, Mohan Sivananthan, Sven Plein, Dudley J Pennell, John P Greenwood  1
Affiliations
Multicenter Study

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

David P Ripley et al. J Cardiovasc Magn Reson. .

Abstract

Background: Aberrant 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.

Methods: Patients 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.

Results: Consecutive 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.

Conclusions: In 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.

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Figures

Figure 1
Figure 1
Examples of several different anomalous coronary arteries imaged by CMR: (A) Right coronary artery originating from the left coronary cusp passing anteriorly (class 2a), (B) Circumflex artery arising from the right coronary cusp (RCC) passing posteriorly (class 3b), (C) Left anterior descending (LAD) artery from the RCC anteriorly passing between the RVOT and aorta (class 4a) and (D) single ostium coronary system arising from the RCC with a retro-aortic circumflex artery and a pre-pulmonic LAD (class 5b). Images reconstructed using SoapBubbleTM software (Philips Medical Systems). Ao - Aorta; RVOT – Right Ventricular Outflow Tract; RA – Right Atrium; LA – Left Atrium.
Figure 2
Figure 2
Kaplan-Meier curves showing the age at which the first major adverse cardiovascular event occurred, demonstrating a significant difference (log rank test, p < 0.0001) between those anomalous coronary arteries from the opposite sinus (ACAOS) with an inter-arterial course (IAC) and those without IAC.
See this image and copyright information in PMC

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