Michael K Cheezum1,2, Brian Ghoshhajra3, Marcio S Bittencourt1,2,4, Edward A Hulten1,2,5, Ami Bhatt6, Negareh Mousavi1,2, Nishant R Shah1, Anne Marie Valente2,7, Frank J Rybicki1, Michael Steigner1, Jon Hainer1, Thomas MacGillivray8, Udo Hoffmann3, Suhny Abbara9, Marcelo F Di Carli1,2, Doreen DeFaria Yeh6, Michael Landzberg2,7, Richard Liberthson6, Ron Blankstein10,2. 1. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 2. Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA. 3. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 4. Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil. 5. Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD, USA. 6. Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 7. Department of Cardiology, Boston Children's Hospital, Boston, MA, USA. 8. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 9. Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 10. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA rblankstein@partners.org.
Abstract
AIMS: The impact of coronary computed tomographic angiography (CTA) on management of anomalous origin of the coronary artery arising from the opposite sinus (ACAOS) remains uncertain. We examined the prevalence, anatomical characterization, and outcomes of ACAOS patients undergoing CTA. METHODS AND RESULTS: Among 5991 patients referred for CTA at two tertiary hospitals between January 2004 and June 2014, we identified 103 patients (1.7% prevalence) with 110 ACAOS vessels. Mean age was 52 years (range 5-83, 63% male), with 55% previously known ACAOS and 45% discovered on CTA. ACAOS subtypes included: 39% interarterial (n = 40 anomalous right coronary artery, n = 3 anomalous left coronary artery), 38% retroaortic, 15% subpulmonic, 5% prepulmonic, and 2% other. ACAOS patients were assessed for symptoms, ischaemic test results, revascularization, all-cause or cardiovascular (CV) death, and myocardial infarction. CTAs were reviewed for ACAOS course, take-off height and angle, length and severity of proximal narrowing, intramural course, and obstructive coronary artery disease (CAD). In follow-up (median 5.8 years), there were 20 surgical revascularizations and 3 CV deaths. After adjusting for obstructive CAD (n = 21/103, 20%), variables associated with ACAOS revascularization included the following: CV symptoms, proximal vessel narrowing ≥50%, length of narrowing >5.4 mm, and an interarterial course. CONCLUSION: The prevalence of ACAOS on CTA was 1.7%, including 45% of cases discovered incidentally. CTA provided excellent characterization of ACAOS features associated with coronary revascularization, including the length and severity of proximal vessel narrowing. Published by Oxford University Press on behalf of the European Society of Cardiology 2016. This work is written by US Government employees and is in the public domain in the US.
AIMS: The impact of coronary computed tomographic angiography (CTA) on management of anomalous origin of the coronary artery arising from the opposite sinus (ACAOS) remains uncertain. We examined the prevalence, anatomical characterization, and outcomes of ACAOS patients undergoing CTA. METHODS AND RESULTS: Among 5991 patients referred for CTA at two tertiary hospitals between January 2004 and June 2014, we identified 103 patients (1.7% prevalence) with 110 ACAOS vessels. Mean age was 52 years (range 5-83, 63% male), with 55% previously known ACAOS and 45% discovered on CTA. ACAOS subtypes included: 39% interarterial (n = 40 anomalous right coronary artery, n = 3 anomalous left coronary artery), 38% retroaortic, 15% subpulmonic, 5% prepulmonic, and 2% other. ACAOS patients were assessed for symptoms, ischaemic test results, revascularization, all-cause or cardiovascular (CV) death, and myocardial infarction. CTAs were reviewed for ACAOS course, take-off height and angle, length and severity of proximal narrowing, intramural course, and obstructive coronary artery disease (CAD). In follow-up (median 5.8 years), there were 20 surgical revascularizations and 3 CV deaths. After adjusting for obstructive CAD (n = 21/103, 20%), variables associated with ACAOS revascularization included the following: CV symptoms, proximal vessel narrowing ≥50%, length of narrowing >5.4 mm, and an interarterial course. CONCLUSION: The prevalence of ACAOS on CTA was 1.7%, including 45% of cases discovered incidentally. CTA provided excellent characterization of ACAOS features associated with coronary revascularization, including the length and severity of proximal vessel narrowing. Published by Oxford University Press on behalf of the European Society of Cardiology 2016. This work is written by US Government employees and is in the public domain in the US.
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