Prevalence of Coronary Artery Anomalies and Associated Complications during Catheter-guided Angiography: A Retrospective Study

Abstract

Introduction: Coronary Artery Anomalies (CAA) refer to very uncommon and unusual morphological features of the epicardial coronary artery that account for 1/5th of deaths in athletes. Patients with CAA are also prone to developing significant Coronary Artery Disease (CAD). Identifying such arteries during catheter-guided angiography is very challenging and is associated with many devastating complications, such as arrhythmia, heart failure, Contrast-Induced Nephropathy (CIN), bleeding, cardio-embolic events, and mechanical injury to the coronary artery, among others. Aim: The aim of this study is to describe the prevalence of various types of coronary anomalies and the complications that arise during catheter-guided angiography. Materials and Methods: A retrospective study was conducted between February 2022 and October 2022, enrolling a total of 2849 patients who underwent angiography for angina or angina equivalents at the catheterisation laboratory, VIMSAR, Burla, Odisha, India. Angiographic records and videos of patients were noted. Coronary anomalies were detected based on quantitative and qualitative criteria provided by the American Heart Association in 2007. The anomalous coronary arteries were classified into three groups: Group A- anomalies of origin and course, Group B- anomalies of intrinsic coronary arterial anatomy, and Group C- anomalies of coronary termination. Data regarding baseline characteristics and procedurerelated complications were collected, compiled, and tabulated to determine the prevalence of different types of coronary anomalies and the arising complications during catheterguided angiography. Results: Among the 2849 enrolled patients, CAA was identified in 64 (2.24%) patients. Of these, CAA with abnormal origin and course (Group A), abnormal termination (Group B), and intrinsic coronary arterial anatomy (Group C) were detected in 36 (1.26%), 4 (0.14%), and 24 (0.84%) patients, respectively. Out of the 64 cases, a total of 13 (20.3%) patients developed different types of complications, including mechanical 2 (3.125%), embolic 1 (1.56%), and arrhythmic 3 (4.68%) complications, bleeding 2 (3.12%), angiographic 3 (4.68%), and left ventricular failure 2 (3.12%), among others. In Group A, complications were more commonly observed in 10 (15.6%) of the cases. Conclusion: CAA with an abnormal origin and course is the most common type of coronary anomaly. Engaging such an artery and detecting its abnormal course are more commonly associated with life-threatening complications. The use of appropriate maneuvers, types and sizes of catheters, and CIN views can help avoid disastrous complications.