Anomalous coronary arteries: location, degree of atherosclerosis and effect on survival—a report from the coronary artery surgery study

Abstract

Limited information is available about clinical presentation, degree of atherosclerosis and effect on overall survival in a large series of patients with coronary artery anomalies. From the National Heart, Lung, and Blood Institute Multicenter Coronary Artery Surgery Study (CASS), detailed coding of coronary angiograms was available in 24,959 patients. Of these patients, 73 (0.3%) had major coronary artery anomalies: 70 had one coronary anomaly and 3 had two coronary anomalies. The most common anomaly involved the circumflex coronary artery (60%). In 69% of these, the circumflex artery arose from a separate ostium in the right coronary sinus, and in 31% it originated as a branch of the right coronary artery. The most common anomalous course was anterior or posterior to the great vessels but not between the great vessels. The major exception to this finding was an anomalous right coronary artery; 7 of 15 such arteries coursed between the great vessels. Anomalous circumflex coronary arteries had a significantly greater degree of stenosis than that in nonanomalous arteries in age- and gender-matched control patients (p = 0.02). Despite this difference, at 7 years there was no significant difference in survival by location or degree of stenosis in the anomalous artery.

Presence of Anomalous Coronary Seen on Angiogram Is Not Associated with Increased Risk of Significant Coronary Artery Disease

“…For instance, Angelini et al reported an incidence of 5.6%, 16 whereas Click et al observed mere 0.3% incidence of anomalies in angiography patients. 17 Some studies have included common innocuous variations in coronary artery anomalies, whereas others have not. This might explain in part the difference in incidence reported between studies.…”

Artéria coronária única submetida a angioplastia com implante de Stent

“…The single coronary artery (SCA), described as an isolated coronary artery, has no gender predominance, being a rare entity with an incidence of 0.024% when isolated, and of 0.03 to 0.04% when associated with other cardiac abnormalities [2][3][4] . Its main characteristic is being originated from the aortic root through a single ostium, with no evidence of a second ostium, being then responsible for the irrigation of the entire heart, independently of its distribution 2 .…”

Anomalous Origin of the Left Coronary Artery From the Noncoronary Cusp: Not a Benign Lesion

“…Origin of the LCA from the noncoronary sinus of Valsalva is an extremely rare disorder, with only case reported in the literature [1][2][3][4][5][6][7][8][9][10][11] and an incidence estimated variously at 0.0008 [10], 0.004 [1], and 0.012% [2]. Some authors [10,11] have suggested that a coronary artery arising from the noncoronary sinus is a benign disorder, although three pediatric case reports in the literature have described sudden death [4,5] or life-threatening arrhythmia [7] associated with this condition.…”