Koichi Nagashima1, Takafumi Hiro1, Daisuke Fukamachi1, Yasuo Okumura1, Ichiro Watanabe1, Atsushi Hirayama1, Masashi Tanaka2, Tomofumi Tanaka3, Itaru Takamisawa3, Isao Taguchi4, Akira Sato5, Kazutaka Aonuma5, Seiji Fukamizu6, Akihiro Nakada6, Atsuyuki Watanabe7, Naofumi Amioka7, Yasuyuki Suzuki8, Naoya Matsumoto8, Junichi Koizumi9, Kazuya Kumagai9, Masanao Naya10, Yoshiharu Higuchi11, Yoshiro Naito12, Tohru Masuyama12, Mitsuharu Kawamura13, Ryusuke Tsunoda14, Susumu Suzuki15, Hideki Ishii15, Toyoaki Murohara15, Takeshi Shimizu16, Yasuchika Takeishi16, Kazuki Shiina17, Jun Yamashita17, Tomohiko Imamura18, Naokata Sumitomo18, Teruo Noguchi19, Toshihide Aso20, Kojiro Furukawa21, Yasuteru Yamauchi22, Kaoru Okishige22, Kenji Sakata23, Masakazu Yamagishi23, Shigeo Shimizu24, Masakazu Ohno24, Teruyasu Sugano25, Koichiro Matsumura26, Kensuke Matsumoto27, Kazuyuki Ozaki28, Shunji Hayashidani29, Hiroshi Meno29, Atsushi Iwata30, Takumi Higuma31, Hirofumi Tomita31, Hideaki Yoshino32, Seiichi Taniai32, Koki Shishido33, Masato Murakami33, Koji Negishi34, Masaki Nii35, Daisuke Wakatsuki36, Hiroshi Suzuki36, Yuji Motoike37, Yukio Ozaki37, Jun Nakazato38, Hidemori Hayashi39, Satoshi Higuchi40, Morio Shoda40. 1. Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan. 2. Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kamicho, Itabashi-ku, Tokyo 173-8610, Japan. 3. Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo 183-0003, Japan. 4. Department of Cardiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama 343-8555, Japan. 5. Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan. 6. Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo 150-0013, Japan. 7. Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama-shi, Okayama 700-8558, Japan. 8. Department of Cardiology, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan. 9. Department of Cardiovascular Surgery, Memorial Heart Center, Iwate Medical University, 9-1, Uchimaru, Morioka city, Iwate 020-8505, Japan. 10. Department of Cardiovascular Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan. 11. Cardiovascular Division, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka 543-0035, Japan. 12. Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. 13. Division of Cardiology, School of Medicine, Showa University, 1-5-8, Hatanodai Shinagawa, Tokyo 142-8555, Japan. 14. Department of Cardiology, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto 861-8520, Japan. 15. Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. 16. Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikariga-oka, Fukushima City 960-1295, Japan. 17. Department of Cardiology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan. 18. Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka-City, Saitama 350-1298, Japan. 19. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan. 20. Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa 232-8555, Japan. 21. Department of Cardiovascular Surgery, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan. 22. Heart Center, Yokohama-City Bay Red Cross Hospital, 3-12-1, Shinnyamashita, Naka-ku, Yokohama-shi, Kanagawa 231-0801, Japan. 23. Department of Cardiovascular and Internal Medicine, Graduate School of Medicine, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8640, Japan. 24. Department of Cardiology, National Hospital Organization, National Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo 190-0014, Japan. 25. Department of Medical Science and Cardiorenal Medicine, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan. 26. Department of Cardiology, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi 570-8507, Japan. 27. Department of Cardiology, The Sakakibara Heart Institute of Okayama, 2-5-1, Nakai-cho, Kita-ku, Okayama 700-0804, Japan. 28. Department of Cardiovascular Biology and Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-dori, Niigata 951-8514, Japan. 29. Division of Cardiology, Fukuoka Red Cross Hospital, 3-1-1 Okusu Minamiku, Fukuoka-shi, Fukuoka 815-8555, Japan. 30. Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan. 31. Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan. 32. Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan. 33. Department of Cardiology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura 247-8533, Japan. 34. Department of Cardiology, Yokohama Municipal Citizens' Hospital, 56 Okasawa-cho, Hodogaya-ku, Yokohama City, Kanagawa 240-8555, Japan. 35. Shizuoka Children's Hospital, 860 Urusiyama, Aoi-ku, Shizuoka 420-8660, Japan. 36. Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa 227-8501, Japan. 37. Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan. 38. Department of Cardiovascular Medicine, Okinawa Prefectural Chubu Hospital, 281 Miyazato, Uruma-city, Okinawa 904-2293, Japan. 39. Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. 40. Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Abstract
AIMS: Anomalous origin of the coronary artery (AOCA) with an inter-arterial course (IAC) between the great vessels poses a risk for a life-threatening cardiovascular event. We assessed, in a registry-based study, the clinical features, treatment strategies, and prognoses of life-threatening cardiovascular events ensuant to AOCA. METHODS AND RESULTS: Included were 65 AOCA patients (48 men/17 women, aged 41 ± 23 years) from 40 clinical centres who had experienced sudden cardiac arrest (SCA) (n = 30), acute myocardial infarction (AMI) (n = 5), angina (n = 23), or syncope (n = 7). The anomalous vessel was the right coronary artery in 72% of patients and left coronary artery in 28%; the ostium was slit-like in 42%. Coronary luminal narrowing ≥75% was absent in patients with SCA or syncope (86% and 57%, respectively), but occlusion or narrowing was seen in those with AMI (100%) or angina (52%). Age ≤40 years, male sex, sporting activity, absence of prodromal symptoms, acutely angled (≤30°) take-off from the aorta, and absence of luminal narrowing of the IAC segment were associated with SCA in this patient group. Coronary vasospasm was inducible in 12 of 17 patients without coronary narrowing. Management included surgical revascularization (n = 26) percutaneous coronary intervention (n = 9), and medical treatment (n = 26). Four SCA patients died while hospitalized; no others died during the median 5.0 (range, 1.8-7.0)-year follow-up period. CONCLUSIONS: In patients with AOCA, age ≤40 years, male sex, sporting activity, and an acute take-off angle appear to be risk factors for SCA. Appropriate management can be beneficial. Confirmation in a large-scale study is warranted. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Anomalous origin of the coronary artery (AOCA) with an inter-arterial course (IAC) between the great vessels poses a risk for a life-threatening cardiovascular event. We assessed, in a registry-based study, the clinical features, treatment strategies, and prognoses of life-threatening cardiovascular events ensuant to AOCA. METHODS AND RESULTS: Included were 65 AOCA patients (48 men/17 women, aged 41 ± 23 years) from 40 clinical centres who had experienced sudden cardiac arrest (SCA) (n = 30), acute myocardial infarction (AMI) (n = 5), angina (n = 23), or syncope (n = 7). The anomalous vessel was the right coronary artery in 72% of patients and left coronary artery in 28%; the ostium was slit-like in 42%. Coronary luminal narrowing ≥75% was absent in patients with SCA or syncope (86% and 57%, respectively), but occlusion or narrowing was seen in those with AMI (100%) or angina (52%). Age ≤40 years, male sex, sporting activity, absence of prodromal symptoms, acutely angled (≤30°) take-off from the aorta, and absence of luminal narrowing of the IAC segment were associated with SCA in this patient group. Coronary vasospasm was inducible in 12 of 17 patients without coronary narrowing. Management included surgical revascularization (n = 26) percutaneous coronary intervention (n = 9), and medical treatment (n = 26). Four SCA patients died while hospitalized; no others died during the median 5.0 (range, 1.8-7.0)-year follow-up period. CONCLUSIONS: In patients with AOCA, age ≤40 years, male sex, sporting activity, and an acute take-off angle appear to be risk factors for SCA. Appropriate management can be beneficial. Confirmation in a large-scale study is warranted. Published on behalf of the European Society of Cardiology. All rights reserved.