SPC365

Anomalous origin of the coronaries arteries – experience of a large volume center encompassing over 25 years

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Tiago Graça Rodrigues

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 12. Coronary Artery Disease (Chronic)
Subtheme: 12.2 Coronary Artery Disease – Epidemiology, Prognosis, Outcome
Session Type: Posters
FP Number: ---
Authors: Tiago Graça Rodrigues; Pedro Carrilho Ferreira; Miguel Nobre Menezes; Nelson Cunha; Catarina Oliveira; Beatriz Garcia; Ana Margarida Martins; Sara Pereira; Pedro Silvério António; Cláudia Jorge; Ana Rita Francisco; João Marques; Fausto j. Pinto; Pedro Pinto Cardoso

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri"><span style="color:#000000"><strong>Introduction&nbsp;</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri"><span style="color:#000000">Anomalous origin of the coronary arteries is a rare congenital condition that may sometimes be associated with significant morbidity and mortality, especially in younger patients. There are few data reporting the characterization and possible risk associations of this disorder.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri"><span style="color:#000000"><strong>Aim&nbsp;</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri"><span style="color:#000000">To describe the anatomical characteristics of anomalous origin of the coronaries arteries and their prognosis implications.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri"><span style="color:#000000"><strong>Methods&nbsp;</strong>Single-centre retrospective study of all patients submitted to diagnostic coronariography in an university hospital between 1993 and 2020. Coronariography findings and clinical parameters were analyzed, and their association with long-term prognosis was determined by Cox regression analysis. Two endpoints were used: all-cause mortality, myocardial infarction and arrhythmic events.</span></span></span></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri"><span style="color:#000000"><strong>Results:&nbsp;</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri"><span style="color:#000000">A total of 47573 coronary angiograms from 40129 patients were performed. Angiographic findings of 29534 patients (62,1% of the total; 65,7% male; age 64&plusmn;12 years) were available for analysis. The overall prevalence of anomalous origins of the coronary arteries was 1.43% (n=423). The most common anomalies were the following: separate origin of the left anterior descending and circumflex arteries (0.78% - n=130); origin of the circumflex artery from the right sinus of Valsalva (0.11% - n=32); origin of the right coronary artery from the left sinus of Valsalva (0.20%, n 59). Anomalous origins of the left main or left anterior descending artery from the right sinus of Valsalva were very rare (0.07% - n=21 and 0.03% -n=9, respectively) as were anomalous origin of the right coronary artery from circumflex and circumflex from right coronary artery (0.003% - n=1 and 0.03% - n=9, respectively).</span></span></span></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri"><span style="color:#000000">Patients with anomalous origins were predominantly male (68.7%), with a mean age of 63&plusmn;11 years, and the most common reasons for performing coronariography were stable angina (31.6%), NSTEMI-ACS (31.2%) and STEMI (12.1%). The mean follow-up time was 34&plusmn;34 months, and the all-cause mortality rate was 16.3% and cardiovascular death was 1.6%. No variant of anomalous origin was associated with long-term prognosis (all cause mortality, myocardial infarction or arrythmic event), even though an anomalous origin of the right coronary artery was associated with an increased rate of PCI of the involved vessel [hazard ratio (HR) = 1.41; 95% CI 1.04-1.73; p=0.001].</span></span></span></p>

<p style="text-align:start"><span style="font-size:11pt"><span style="font-family:Calibri"><span style="color:#000000"><strong>Conclusions&nbsp;</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri"><span style="color:#000000">In this study anomalous origin of the coronary arteries was a relatively common finding on coronary angiography. No single anomaly was associated with worse long-term prognosis, namely mortality, possibly due to the small incidence of high-risk cases, as well as therapeutic intervention when indicated. However, an anomalous origin of the right coronary artery was associated with increased PCI due to progression of atherosclerosis disease. Separate origin of the left anterior and circumflex arteries was the most common finding.</span></span></span></p>