High Risk Anomalous Origin of the Right Coronary Artery

AbstractAnomalous origin of the right coronary artery from the opposite sinus (right-ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomography angiography (CCTA) has led to increased recognition of this condition, even among healthy individuals. Our study sought to examine the prevalence, anatomical characteristics, and outcomes of right-ACAOS with IAC in patients undergoing CCTA for suspected coronary artery disease (CAD). We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital from January 2012 to December 2020. Patients exhibiting right-ACAOS with IAC were analyzed for cardiac symptoms and mid-term occurrence of first MACE (cardiac death, SCD, non-fatal myocardial infarction (MI) or revascularization of the anomalous vessel). CCTAs were reviewed for anatomical high-risk features and concomitant CAD. Among 10,928 patients referred for CCTA, 28 patients with right-ACAOS with IAC were identified. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented stable cardiac symptoms. Most patients had at least one high risk anatomical feature. During follow-up, there were no cardiac deaths or aborted SCD episodes and only 1 patient underwent surgical revascularization of the anomalous vessel. Right-ACAOS with IAC is an uncommon finding (prevalence of 0.26%). In a contemporary population of predominantly asymptomatic patients who survived this condition well into adulthood, most patients were managed conservatively with a low event rate. Additional studies are needed to support medical follow-up as the preferred option in this setting.

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HIGH-RISK ANATOMICAL FEATURES IN A PATIENT WITH ANOMALOUS ORIGIN OF THE RIGHT CORONARY ARTERY MANAGED WITH PERCUTANEOUS CORONARY INTERVENTION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)03855-9 ◽

2021 ◽

Vol 77 (18) ◽

pp. 2500

Author(s):

Fabio Solis-Jimenez ◽

Montserrat Villalobos Pedroza ◽

Jose Antonio Cornejo Guerra ◽

Alejandro Ezquerra ◽

Jorge Sanchez ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

High Risk ◽

Right Coronary Artery ◽

Coronary Intervention ◽

Anomalous Origin ◽

Anatomical Features ◽

Percutaneous Coronary ◽

The Right

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Anomalous Origin of the Right Coronary Artery With Interarterial Course: Red Flag or Innocent Bystander?

10.21203/rs.3.rs-558192/v1 ◽

2021 ◽

Author(s):

Francisco Albuquerque ◽

Pedro De Araújo Gonçalves ◽

Hugo Marques ◽

António M. Ferreira ◽

Pedro Freitas ◽

...

Keyword(s):

Coronary Artery ◽

High Risk ◽

Right Coronary Artery ◽

Suspected Coronary Artery Disease ◽

Anomalous Origin ◽

Cardiac Symptoms ◽

Asymptomatic Patients ◽

Increased Risk ◽

The Right

Abstract Purpose: Anomalous origin of the right coronary artery from the opposite sinus (right-ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomography angiography (CCTA) has led to increasing recognition of this condition, even among healthy individuals. Our study sought to examine the prevalence, anatomical characteristics and outcomes of right-ACAOS with IAC in patients undergoing CCTA for suspected coronary artery disease (CAD).Methods: We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital from January 2012 to December 2020. Right-ACAOS with IAC patients were analyzed for cardiac symptoms and long-term occurrence of first MACE (SCD, non-fatal myocardial infarction (MI) or revascularization of the anomalous vessel). CCTAs were reviewed for anatomical high-risk features and concomitant CAD. Results: Among 10928 patients referred for CCTA, 28 patients with right-ACAOS with IAC were identified. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented with stable cardiac symptoms. Most patients had at least one high risk anatomical feature. During follow-up, there were no CV deaths or aborted SCD episodes and only 1 patient underwent surgical revascularization of the anomalous vessel.Conclusions: Right-ACAOS with IAC is an uncommon finding (prevalence of 0.26%). In a contemporary population of predominantly asymptomatic patients who survived this condition well into adulthood, most patients were managed conservatively with a low event rate. Additional studies are needed to support medical follow-up as the preferred option in this setting.

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Anomalous origin of the right coronary artery with interarterial course: red flag or innocent bystander?

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab111.019 ◽

2021 ◽

Vol 22 (Supplement_3) ◽

Author(s):

F Albuquerque ◽

P De Araujo Goncalves ◽

H Marques ◽

A Ferreira ◽

P Freitas ◽

...

Keyword(s):

Coronary Artery ◽

High Risk ◽

Right Coronary Artery ◽

Anomalous Origin ◽

Long Term Outcomes ◽

Cardiac Symptoms ◽

Increased Risk ◽

The Right

Abstract Funding Acknowledgements Type of funding sources: None. Background Anomalous origin of the right coronary artery (right ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomographic angiography (CCTA) has led to increasing recognition of this condition, even among healthy individuals. This study sought to examine the prevalence, anatomical characteristics and outcomes of right ACAOS with IAC in patients undergoing CCTA for all-indications. Methods We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital between January 2012 and December 2020. Right ACAOS patients with IAC were analyzed for cardiac symptoms (anginal chest pain, syncope, aborted SCD) and long-term outcomes were evaluated for myocardial infarction, ischemic test results, revascularization procedures and all-cause or cardiovascular (CV) mortality. CCTAs were reviewed for proposed high-risk features (ie., take-off angle, length and severity of proximal narrowing, intramural course, interarterial length) and concomitant coronary artery disease (CAD). Association between high-risk features was analyzed. Long-term outcomes were evaluated. Results Among 10,928 patients referred for CCTA during the study period, we identified 28 patients (0.3% prevalence) with right ACAOS and IAC. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented cardiac symptoms. During a median follow-up of 44.1 ± 31.8 months, there were no CV deaths and only 1 patient (3.65%) underwent surgical revascularization. Baseline characteristics and CCTA findings are presented in figure 1. Conclusion Right ACAOS and IAC is an uncommon finding, with an observed prevalence of 0.3%. CCTA provides excellent anatomical characterization of anomalous vessels, including suggested high-risk features. In a population of asymptomatic patients who survived this condition well into adulthood, the risk of events was very low and medical follow up might be a reasonable option.

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