Is the Prevalence of Coronary Artery Anomalies Different in Countries with Small Populations? – A Retrospective Study in Northern Cyprus
DOI:
https://doi.org/10.1532/hsf.4203Keywords:
Keywords: coronary artery anomalies, coronary artery fistulae, coronary angiography,coronary dominanceAbstract
Background: Although the prevalence of coronary artery anomalies (CAA) is due to accidental and rare discoveries, it varies between different countries or geographies. CAA are rare congenital disorders having various clinical definitions. Its prevalence varies in angiographic and autopsy series in adult populations and is approximately 1% in average. While the incidence ranges from 0.2% to 5.64% in coronary angiographic (CAG) studies, it is around 0.3% in autopsy series. We aimed to estimate the frequency of CAA in our patient population.
Methods: The coronary angiographic data of 4099 consecutive adult patients, who underwent CAG between January 2019 and December 2020, were analyzed and retrospectively studied.
Results: The mean age of the total patients who underwent CAG was 61.59 ± 13.67 years (range, 18-98 years). CAA were found in 76 patients (1.85% incidence), origin and course anomaly in 62 patients (81.6%), and coronary artery termination anomaly in 14 patients (18.4%). Separate exits of the left anterior descending (LAD) and left circumflex (LCX) coronary artery from the left sinus of Valsalva (LSV) were the most common anomalies (36.84%). Coronary artery fistulas were seen in 14 (18.42%) patients. Abnormal origin of left circumflex artery (LCX) from the right coronary artery (RCA) or right sinus valsalva (RSV) was seen in 13 (17.11%) patients. Outflow anomalies from the contralateral coronary sinus were detected in 10 (13.16%) patients.
Conclusion: The incidence and pattern of CAA in our patient population showed similarity with previous studies. Physicians should be aware of CAA that may be associated with potentially serious cardiac incidents, because recognition of these CAA is important for the decision of treatment procedures.
References
Almeida AS, Fuchs SC, Fuchs FC, et al. 2020. Effectiveness of clinical, surgical and percutaneous treatment to prevent cardiovascular events in patients referred for elective coronary angiography: an observational study. Vascular Health and Risk Management. 16:285-297.
Angelini P, Velasco JA, Flamm S. 2002. Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation. 105:2449–54.
Aydinlar A, Çiçek D, Sentürk T, et al. 2005. Primary Congenital Anomalies of the Coronary Arteries A Coronary Arteriographic Study in Western Turkey. International heart journal. 46:97-103.
Bazzocchi G, Romagnoli A, Sperandio M, et al. 2011. Evaluation with 64-slice CT of the prevalence of coronary artery variants and congenital anomalies: a retrospective study of 3,236 patients. La Radiol Med. 116:675–89.
Budoff MJ, Ahmed V, Gul KM, Mao SS, Gopal A. 2006. Coronary anomalies by cardiac computed tomographic angiography. Clinical Cardiology: An International Indexed and Peer-Reviewed Journal for Advances in the Treatment of Cardiovascular Disease. 29: 489-93.
Chu E, Cheitlin MD. 1993. Diagnostic considerations in patients with suspected coronary artery anomalies. Am Heart J. 126: 1427–1438.
Ciesunski G, Rapprich B, Kober G. 1993. Coronary anomalies: incidence and importance. Clinical cardiology. 16:711-5.
Cohen MG, Tolleson TR, Peter RH, Harrison JK, Sketch Jr MH. 2002. Successful percutaneous coronary intervention with stent implantation in anomalous right coronary arteries arising from the left sinus of valsalva: a report of two cases. Catheterization and cardiovascular interventions. 55: 105-8.
Conkbayir C, Coskun U, Oztas DM, et al. 2019. Coronary Arteries Arising from Single Coronary Ostium: A Case Report. Heart Surg Forum. 22:E269-E270.
Desmet W, Vanhaecke J, Vrolix M, et al. 1992. Isolated single coronary artery: a review of 50,000 consecutive coronary angiographies Eur Heart J. 13:1637-40.
Earls JP. 2006. Coronary artery anomalies. Techniques in vascular and interventional radiology. 9: 210-7.
Erez E, Tam VK, Doublin NA, Stakes J. 2006. Anomalous coronary artery with aortic origin and course between the great arteries: improved diagnosis, anatomic findings, and surgical treatment. The Annals of thoracic surgery. 82:973-7.
Eyuboglu M, Ekinci MA, Karakoyun S, et al. 2016. Fragmented QRS for risk stratification in patients undergoing first diagnostic coronary angiography. Arq Bras Cardiol. 107:299–304.
Jiang X, Zhou P, Wen C, et al. 2021. Coronary Anomalies in 11,267 Southwest Chinese Patients Determined by Angiography. BioMed Research International. 6693784.
Kardos A, Babai L, Rudas L, et al. 1997. Epidemiology of congenital coronary artery anomalies: a coronary arteriography study on a central European population. Catheterization and cardiovascular diagnosis. 42:270-5.
Kashyap JR, Kumar S. 2021. Prevalence and Pattern of Congenital Coronary Artery Anomalies in Patients Undergoing Coronary Angiography at a Tertiary Care Hospital of Northern India. Cureus. 13:e14399.
Knaapen M, Koch AH, Koch C, et al. 2013. Prevalence of left and balanced coronary arterial dominance decreases with increasing age of patients at autopsy. A postmortem coronary angiograms study. Cardiovasc Pathol. 22:49–53.
Kuno T, Numasawa Y, Miyata H, et al. 2013. Impact of coronary dominance on in-hospital outcomes after percutaneous coronary intervention in patients with acute coronary syndrome. PLoS One. 8:e72672.
Liberthson RR. 1996. Sudden death from cardiac causes in children and young adults. New England Journal of Medicine. 334:1039-44.
Liberthson RR, DINSMORE RE, Bharati S, et al. 1974. Aberrant coronary artery origin from the aorta: diagnosis and clinical significance. Circulation. 50:774-9.
Lim JJ, Jung JI, Lee BY, Lee HG. 2014. Prevalence and types of coronary artery fistulas detected with coronary CT angiography. American Journal of Roentgenology. 203:W237-43.
Lipton MJ, Barry WH, Obrez I, Silverman JF, Wexler L. 1979. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance. Radiology. 130:39-47.
Maleszka A, Kleikamp G, Minami K, Peterschröder A, Körfer R. 2005. Giant coronary arteriovenous fistula. Zeitschrift für Kardiologie. 94:38-43.
Menke DM, Waller BF, Bless JE. 1985. Hypoplastic coronary arteries and high takeoff position of the right coronary ostium: a fatal combination of congenital coronary artery anomalies in an amateur athlete. Chest. 88: 299-301.
Montaudon M, Latrabe V, Iriart X, Caix P, Laurent F. 2007. Congenital coronary arteries anomalies: review of the literature and multidetector computed tomography (MDCT)-appearance. Surgical and Radiologic Anatomy. 29: 343-55.
Moriwaki K, Dohi K, Omori T, et al. 2017. A survival case of fulminant right-side dominant eosinophilic myocarditis. Int Heart J. 58:459–62.
Peng L, Guo X, Gao Y, et al. 2018. Impact of right coronary dominance on triple-vessel coronary artery disease: A cross-sectional study. Medicine (Baltimore). 97:e11685.
Qureshi SA. 2006. Coronary arterial fistulas. Orphanet Journal of Rare Diseases. 1:1-51.
Rao SS, Agasthi P. 2021. Coronary Artery Fistula. StatPearls [Internet]. Treasure Island FL: StatPearls Publishing.
Sidhu NS, Wander GS, Monga A, Kaur A. 2019. Incidence, characteristics and atherosclerotic involvement of coronary artery anomalies in adult population undergoing catheter coronary angiography. Cardiology research. 10:358-368.
Sunkara A, Chebrolu LH, Chang SM,Barker C. 2017. Coronary artery fistula. Methodist DeBakey cardiovascular journal. 13:78-80.
Turkmen S, Cagliyan CE, Poyraz F, et al. 2013. Coronary arterial anomalies in a large group of patients undergoing coronary angiography in southeast Turkey. Folia morphologica. 72:123-7.
Vasheghani-Farahani A, Kassaian SE, Yaminisharif A, et al. 2008. The association between coronary arterial dominancy and extent of coronary artery disease in angiography and paraclinical studies. Clin Anat (New York, NY). 21:519–23.
Verdini D, Vargas D, Kuo A, et al. 2016. Coronary-pulmonary artery fistulas. Journal of thoracic imaging. 31:380-390.
Wilkins CE, Betancourt B, Mathur VS, Massumi A, et al. 1988. Coronary artery anomalies: a review of more than 10,000 patients from the Clayton Cardiovascular Laboratories. Texas Heart Institute Journal. 15:166-73.
Yamanaka O, Hobbs RE. 1990. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Catheterization and cardiovascular diagnosis. 21:28-40.
Yaymaci B, Ugurlucan M, Basaran M, et al. 2010. Solitary coronary artery nourishing the entire heart. Ann Saudi Med. 30:81-3.
Yildiz A, Okcun B, Peker T, et al. 2010. Prevalence of coronary artery anomalies in 12,457 adult patients who underwent coronary angiography. Clinical cardiology. 33: E60-4.
Yuksel S, Meric M, Soylu K, et al. 2013. The primary anomalies of coronary artery origin and course: a coronary angiographic analysis of 16,573 patients. Experimental & Clinical Cardiology. 18: 121-3.