Anomalous origin of the coronary artery from the wrong coronary sinus evaluated with computed tomography: “High-risk” anatomy and its clinical relevance

• Published in: European radiology Vol. 24; no. 10; pp. 2353 - 2359
• Main Authors: Krupiński, Maciej, Urbańczyk-Zawadzka, Małgorzata, Laskowicz, Bartosz, Irzyk, Małgorzata, Banyś, Robert, Klimeczek, Piotr, Gruszczyńska, Katarzyna, Baron, Jan
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2014; Springer Nature B.V
• Subjects: Cardiac; Cardiovascular disease; Chest Pain - diagnostic imaging; Chest Pain - epidemiology; Chest Pain - etiology; Contrast agents; Coronary Sinus - abnormalities; Coronary Sinus - diagnostic imaging; Coronary Vessel Anomalies - complications; Coronary Vessel Anomalies - diagnostic imaging; Coronary vessels; Diagnosis, Differential; Diagnostic Radiology; Dimensional analysis; Female; Heart; Humans; Imaging; Internal Medicine; Interventional Radiology; Male; Medicine; Medicine & Public Health; Middle Aged; Multidetector Computed Tomography - methods; Neuroradiology; Poland - epidemiology; Prevalence; Radiology; Risk Factors; Tomography; Ultrasound; Germany; Coronary vessel anomalies; Anatomy; Multislice computed tomography; Follow-up studies; Cardiovascular abnormalities
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-014-3238-2

Objective
The aim of the study was to assess coronary arteries arising from the wrong coronary sinus, including CT-evaluated high-risk anatomic features, clinical symptoms and cardiac events during follow-up.
Methods
A total of 7,115 patients scheduled for 64-slice or dual-source cardiac CT were screened for the presence of isolated anomalous origin of the coronary artery from the wrong coronary sinus.
Results
Anomalous origin of the coronary artery was found in 54 (0.76 %) patients (29 men, 25 women, mean age 60.9 ± 11.6 years). Sixteen (30 %) patients with abnormal right coronary origin (ARCA) more commonly had a slit-like orifice (15 vs. 3;
p
 < 0.001), intramural course (15 vs. 3;
p
 < 0.001) and interarterial course (11 vs. 0;
p
 < 0.001) than 22 (41 %) and 13 (24 %) individuals with abnormal circumflex artery (ALCx) and left coronary artery (ALCA) origin, respectively. Patients with ALCA presented less frequently with chest pain than subjects with ARCA and ALCx (25 vs. 3;
p
 = 0.03). Patients with ARCA tended to show higher occurrence of cardiac events in the follow-up than individuals with ALCA and ALCx (5 vs. 4;
p
 = NS).
Conclusions
High-risk anatomy features are most common in patients with ARCA and these patients also have higher prevalence of chest pain and cardiac events in the follow-up than individuals with ALCA and ALCx.
Key Points
•
Multislice computed tomography enables detection and evaluation of the coronary artery anomalies
.
•
Anomalous anatomy of the coronary artery potentially influences the prevalence of adverse events
.
•
Adverse events tend to be most common in anomalous right coronary arteries
.