Anomalous origin of the coronary artery arising from the opposite sinus: prevalence and outcomes in patients undergoing coronary CTA

Michael K. Cheezum, Brian Ghoshhajra, Marcio S. Bittencourt, Edward A. Hulten, Ami Bhatt, Negareh Mousavi, Nishant R. Shah, Anne Marie Valente, Frank J. Rybicki, Michael Steigner, Jon Hainer, Thomas MacGillivray, Udo Hoffmann, Suhny Abbara, Marcelo F. Di Carli, Doreen DeFaria Yeh, Michael Landzberg, Richard Liberthson, Ron Blankstein

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

AIMS: The impact of coronary computed tomographic angiography (CTA) on management of anomalous origin of the coronary artery arising from the opposite sinus (ACAOS) remains uncertain. We examined the prevalence, anatomical characterization, and outcomes of ACAOS patients undergoing CTA.

METHODS AND RESULTS: Among 5991 patients referred for CTA at two tertiary hospitals between January 2004 and June 2014, we identified 103 patients (1.7% prevalence) with 110 ACAOS vessels. Mean age was 52 years (range 5-83, 63% male), with 55% previously known ACAOS and 45% discovered on CTA. ACAOS subtypes included: 39% interarterial (n = 40 anomalous right coronary artery, n = 3 anomalous left coronary artery), 38% retroaortic, 15% subpulmonic, 5% prepulmonic, and 2% other. ACAOS patients were assessed for symptoms, ischaemic test results, revascularization, all-cause or cardiovascular (CV) death, and myocardial infarction. CTAs were reviewed for ACAOS course, take-off height and angle, length and severity of proximal narrowing, intramural course, and obstructive coronary artery disease (CAD). In follow-up (median 5.8 years), there were 20 surgical revascularizations and 3 CV deaths. After adjusting for obstructive CAD (n = 21/103, 20%), variables associated with ACAOS revascularization included the following: CV symptoms, proximal vessel narrowing ≥50%, length of narrowing >5.4 mm, and an interarterial course.

CONCLUSION: The prevalence of ACAOS on CTA was 1.7%, including 45% of cases discovered incidentally. CTA provided excellent characterization of ACAOS features associated with coronary revascularization, including the length and severity of proximal vessel narrowing.

Original languageEnglish (US)
Pages (from-to)224-235
Number of pages12
JournalEuropean Heart Journal Cardiovascular Imaging
Volume18
Issue number2
DOIs
StatePublished - Feb 1 2017

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Coronary Vessels
Angiography
Coronary Artery Disease
Tertiary Care Centers
Myocardial Infarction

Keywords

  • anomalous coronary artery
  • coronary computed tomographic angiography
  • prognosis
  • revascularization
  • sudden cardiac death

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Anomalous origin of the coronary artery arising from the opposite sinus : prevalence and outcomes in patients undergoing coronary CTA. / Cheezum, Michael K.; Ghoshhajra, Brian; Bittencourt, Marcio S.; Hulten, Edward A.; Bhatt, Ami; Mousavi, Negareh; Shah, Nishant R.; Valente, Anne Marie; Rybicki, Frank J.; Steigner, Michael; Hainer, Jon; MacGillivray, Thomas; Hoffmann, Udo; Abbara, Suhny; Di Carli, Marcelo F.; DeFaria Yeh, Doreen; Landzberg, Michael; Liberthson, Richard; Blankstein, Ron.

In: European Heart Journal Cardiovascular Imaging, Vol. 18, No. 2, 01.02.2017, p. 224-235.

Research output: Contribution to journalArticle

Cheezum, MK, Ghoshhajra, B, Bittencourt, MS, Hulten, EA, Bhatt, A, Mousavi, N, Shah, NR, Valente, AM, Rybicki, FJ, Steigner, M, Hainer, J, MacGillivray, T, Hoffmann, U, Abbara, S, Di Carli, MF, DeFaria Yeh, D, Landzberg, M, Liberthson, R & Blankstein, R 2017, 'Anomalous origin of the coronary artery arising from the opposite sinus: prevalence and outcomes in patients undergoing coronary CTA', European Heart Journal Cardiovascular Imaging, vol. 18, no. 2, pp. 224-235. https://doi.org/10.1093/ehjci/jev323
Cheezum, Michael K. ; Ghoshhajra, Brian ; Bittencourt, Marcio S. ; Hulten, Edward A. ; Bhatt, Ami ; Mousavi, Negareh ; Shah, Nishant R. ; Valente, Anne Marie ; Rybicki, Frank J. ; Steigner, Michael ; Hainer, Jon ; MacGillivray, Thomas ; Hoffmann, Udo ; Abbara, Suhny ; Di Carli, Marcelo F. ; DeFaria Yeh, Doreen ; Landzberg, Michael ; Liberthson, Richard ; Blankstein, Ron. / Anomalous origin of the coronary artery arising from the opposite sinus : prevalence and outcomes in patients undergoing coronary CTA. In: European Heart Journal Cardiovascular Imaging. 2017 ; Vol. 18, No. 2. pp. 224-235.
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AU - Cheezum, Michael K.

AU - Ghoshhajra, Brian

AU - Bittencourt, Marcio S.

AU - Hulten, Edward A.

AU - Bhatt, Ami

AU - Mousavi, Negareh

AU - Shah, Nishant R.

AU - Valente, Anne Marie

AU - Rybicki, Frank J.

AU - Steigner, Michael

AU - Hainer, Jon

AU - MacGillivray, Thomas

AU - Hoffmann, Udo

AU - Abbara, Suhny

AU - Di Carli, Marcelo F.

AU - DeFaria Yeh, Doreen

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AU - Liberthson, Richard

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N2 - AIMS: The impact of coronary computed tomographic angiography (CTA) on management of anomalous origin of the coronary artery arising from the opposite sinus (ACAOS) remains uncertain. We examined the prevalence, anatomical characterization, and outcomes of ACAOS patients undergoing CTA.METHODS AND RESULTS: Among 5991 patients referred for CTA at two tertiary hospitals between January 2004 and June 2014, we identified 103 patients (1.7% prevalence) with 110 ACAOS vessels. Mean age was 52 years (range 5-83, 63% male), with 55% previously known ACAOS and 45% discovered on CTA. ACAOS subtypes included: 39% interarterial (n = 40 anomalous right coronary artery, n = 3 anomalous left coronary artery), 38% retroaortic, 15% subpulmonic, 5% prepulmonic, and 2% other. ACAOS patients were assessed for symptoms, ischaemic test results, revascularization, all-cause or cardiovascular (CV) death, and myocardial infarction. CTAs were reviewed for ACAOS course, take-off height and angle, length and severity of proximal narrowing, intramural course, and obstructive coronary artery disease (CAD). In follow-up (median 5.8 years), there were 20 surgical revascularizations and 3 CV deaths. After adjusting for obstructive CAD (n = 21/103, 20%), variables associated with ACAOS revascularization included the following: CV symptoms, proximal vessel narrowing ≥50%, length of narrowing >5.4 mm, and an interarterial course.CONCLUSION: The prevalence of ACAOS on CTA was 1.7%, including 45% of cases discovered incidentally. CTA provided excellent characterization of ACAOS features associated with coronary revascularization, including the length and severity of proximal vessel narrowing.

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KW - anomalous coronary artery

KW - coronary computed tomographic angiography

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KW - sudden cardiac death

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