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Anomalous origin of the right coronary artery with interarterial course: red flag or innocent bystander?
Session:
Posters - B. Imaging
Speaker:
Francisco Albuquerque
Congress:
CPC 2021
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.2 Computed Tomography
Session Type:
Posters
FP Number:
---
Authors:
Francisco Albuquerque; Pedro de Araújo Gonçalves; Hugo Marques; António m. Ferreira; Pedro Freitas; Pedro m. Lopes; Mariana Gonçalves; Hélder Dores; Nuno Cardim
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Times New Roman",serif">[Background]</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">Anomalous origin of the right coronary artery (right ACAOS) with an interarterial course has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomographic angiography (CCTA) has led to increasing recognition of this condition, even among apparently healthy individuals. This study sought to examine the prevalence, anatomical characterization and outcomes of right ACAOS with an interarterial course in patients undergoing CCTA for all-indications. </span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Times New Roman",serif">[Methods]</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital between January 2012 and December 2020. Right ACAOS patients with an interarterial course were assessed for cardiac symptoms (anginal chest pain, syncope, aborted SCD), myocardial infarction, ischemic test results, revascularization and all-cause or cardiovascular (CV) death. CCTAs were reviewed for take-off height and angle, length and severity of proximal narrowing, intramural course, interarterial length and concomitant coronary artery disease (CAD). Patients were divided in two anatomical risk categories according to published literature. Outcomes were evaluated in patients with at least 1 year of follow-up. </span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Times New Roman",serif">[Results]</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">Among 10928 patients referred for CCTA during the study period, we identified 28 patients (0.3% prevalence) with right ACAOS and interarterial course. Mean age was 55 ± 17 years, 64% were male and 10 (36%) presented cardiac symptoms. Only 1 patient underwent surgery. During a median follow-up of 4.3 years, there were no CV deaths and only 1 patient (5%) has experienced an adverse event (syncope of undetermined cause). Clinical and CCTA findings are presented in table 1. </span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Times New Roman",serif">[Conclusion]</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">Right ACAOS is an uncommon finding, with an observed prevalence of 0.3%. CCTA provides excellent characterization of anatomical features, including the length and severity of proximal vessel narrowing. In a population of predominantly asymptomatic patients who survived this condition well into adulthood, the risk of events was very low and medical follow up might be a reasonable option.</span></span></span></p>
Slides
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