Prevalence and Pattern of Congenital Coronary Artery Anomalies in Patients Undergoing Coronary Angiography at a Tertiary Care Hospital of Northern India

Abstract

Objectives: To evaluate the prevalence and pattern of congenital coronary artery anomalies (CAAs) in the adult population undergoing catheter coronary angiography.Methods: The coronary angiograms done between October 2015 and September 2020 were reviewed for the presence of coronary anomalies based upon Angelini's classification. The medical record of patients with anomalies was reviewed for symptomatology and indication of angiography.Results: CAAs were found in 129 (87 males and 42 females) of 6,258 patients giving a prevalence of 2.06%. The mean age was 57.8 ± 11.8 (range 32-81) years. Among these, the anomalous origin and course of the coronaries were the most common anomaly seen in 81 (1.29%) patients, followed by intrinsic anomalies of the coronary arterial system in 44 (0.7%) patients and anomalies of coronary termination and anomalous anastomotic vessels in 2 (0.03%) patients each. Overall, the absence of the left main trunk with a separate origin of the left anterior descending (LAD) and the circumflex artery was the commonest anomaly seen in 46 (0.74%) patients, followed by dual LAD in 35 (0.56%) patients. The anomalous origin of the right coronary artery (RCA) from the left sinus was seen in 14 patients (0.22%) and that of the circumflex artery from the right sinus or right coronary artery was seen in 11 patients (0.17%). The origin of the left main and RCA from ascending aorta was found in eight (0.13%) patients. One (0.02%) patient had a single coronary artery, and another one (0.02%) had all the three coronary arteries arising from the right sinus; however, with separate ostia. The split RCA was seen in nine (0.14%) patients and there were two (0.03%) patients each of coronary artery fistulae, and of anomalous anastomotic vessels.Conclusions: The prevalence of congenital coronary anomalies in this study was 2.06%. The commonest anomaly was that of origin and courses of the vessels, however, the pattern of anomalies is different from previous studies.

Prevalence and Pattern of Congenital Coronary Artery Anomalies in Patients Undergoing Coronary Angiography at a Tertiary Care Hospital

“…Similarly, high prevalence rates have been reported by (0.22%). 11 However, some studies have shown lower occurrence rates, with a prevalence of 0.10% and 0.1%. 12,13 With inter-arterial RCA patients showed the increased risk for myocardial ischemia, which can lead to life-threatening clinical manifestations.…”

“…The clinical manifestations of this CAA variant are negligible. 11,13 Thirteen patients (0.36 %) had RCAs that originated in the posterior wall of the right coronary sinus. It has a relatively low incidence rate of 0.16 percent and may be harmless.…”

Frequency of Coronary Artery Anomalies Undergoing Coronary Interventions Patients at Tertiary Hospital

“…Amongst which 0.51% incidence was shown in the anomalous area right coronary artery (RCA) from a left coronary sinus (LCS), thus making it the leading type of anomaly. Similarly, Jeet R et al reported an incidence of 2.06% of coronary artery anomaly after reviewing, 6,258 coronary angiograms in the age ranging from 51-60 years [1]. With 1.29 percent, the most prevalent abnormality was anomalous origin and course of arteries, followed by intrinsic abnormalities of coronary arterial system anomalies of coronary termination and anomalous anastomotic vessels, at 0.7 percent and 0.03 percent, respectively.…”

“…The rare congenital disorder "Coronary Artery Anomalies (CAA)" varies differently in clinical presentation and on average 1% of the adult population represents in autopsy [1]. Out of 80% of the coronary artery anomalies are benign in nature and on angiographic profile, 0.1%-1.3% of patients are reported of anomalous coronary arteries [2].…”

Classification, diagnosis and clinical strategy of congenital coronary artery disease in children

“…Furthermore, according to the risk of adverse cardiac events CCAA can be separated into three kinds: benign coronary anomalies (BCA), potentially serious coronary anomalies(PSCA), serious coronary anomalies(SCA); which refers to CCAA-BCA, CCAA-PSCA and CCAA-SCA, in order to help clinicians better understand and identify the related diseases. See Table 1 for abbreviations and Table 2 for details (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”