Congenital coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography

Abstract

BackgroundAs coronary computed tomography angiography (CCTA) has emerged as a non-invasive alternative for evaluation of coronary anatomy with a lower referral threshold than invasive coronary angiography (ICA), the prevalence of coronary anomalies in CCTA may more closely reflect the true prevalence in the general population. Morphological features of coronary anomalies can be evaluated more precisely by CCTA than by ICA, which might lead to a higher identification of congenital coronary anomalies in CCTA compared to ICA.To evaluate the incidence, clinical and morphological features of the anatomy of patients with coronary anomalies detected either by coronary computed tomography angiography (CCTA) with prospective ECG-triggering or invasive coronary angiography (ICA).MethodsConsecutive patients underwent 64-slice CCTA (n = 1′759) with prospective ECG-triggering or ICA (n = 9′782) and coronary anatomy was evaluated for identification of coronary anomalies to predefined criteria (origin, course and termination) according to international recommendations.ResultsThe prevalence of coronary anomalies was 7.9% (n = 138) in CCTA and 2.1% in ICA (n = 203; p < 0.01). The most commonly coronary anomaly detected by CCTA was myocardial bridging 42.8% (n = 59) vs. 21.2% (n = 43); p < 0.01, while with ICA an absent left main trunk was the most observed anomaly 36.0% (n = 73; p < 0.01). In 9.4% (n = 13) of identified coronary anomalies in CCTA 9.4% were potentially serious coronary anaomalies, defined as a course of the coronary artery between aorta and pulmonary artery were identified.ConclusionThe prevalence of coronary anomalies is substantially higher with CCTA than ICA even after exclusion of patients with myocardial bridging which is more frequently found with CCTA. This suggests that the true prevalence of coronary anomalies in the general population may have been underestimated based on ICA.

Role of MDCT - Coronary Angiography in the Evaluation of Coronary Artery Anomalies and Incidence of Coronary Artery Anomalies in a Subset of South Indian Population

“…Anomalies of coronary termination. (4,5) We did not encounter any case of anomaly of coronary artery termination.…”

“…(4) However with the increasing use of MDCT angiography, the prevalence of coronary artery anomalies have increased. In our study the prevalence was about 6.4 %.…”

“…(3,4) MDCTCoronary angiography is better than conventional angiography in delineating the ostial origin and proximal path of an anomalous coronary. Increased use of MDCT in cardiac imaging highlights the value of recognizing such anomalies on cross-sectional, multiplanar, and volumerendered reconstructions.…”

Coronary artery anomalies overview: The normal and the abnormal

“…However, its widespread use is limited due the dose of ionizing radiation and the use of contrast agents, in particular taking into account that most patients are young. A recent study showed that the prevalence of CAAs is substantially higher with CT than coronary angiography, suggesting a possible underestimation of CAAs based on invasive angiography [53] . CMR is capable of visualizing the origin of the coronary arteries non-invasively, without use of ionizing radiation and contrast agents.…”

Ectopic Origin of the Left Anterior Descending Artery from the Proximal Right Coronary Artery: An Imaging Report

“…Coronary CT offers the best performance in terms of spatial resolution, acquisition time, and image contrast. Furthermore, in a study comparing coronary CT and coronary angiography, it was demonstrated that the prevalence of coronary anomalies detected was substantially higher by coronary CT [3]. …”