Coronary artery anomalies: a review of more than 10,000 patients from the Clayton Cardiovascular Laboratories
C E Wilkins1, B Betancourt, V S Mathur
1Clayton Foundation for Research Cardiovascular Laboratories and the Department of Cardiology, St. Luke's Episcopal Hospital and the Texas Heart Institute, Houston, Texas, USA.
Insights
Coronary artery anomalies were found in 94 patients, with the most common being the left circumflex coronary artery originating from the right coronary artery. This anomaly was associated with a high incidence of coronary atherosclerosis.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- Coronary artery anomalies are relatively rare but can have significant clinical implications.
- Previous studies have not consistently linked anomalous coronary arteries to increased atherosclerosis.
- Understanding the relationship between coronary artery anomalies and atherosclerosis is crucial for patient management.
Purpose of the Study:
- To investigate the clinical and angiographic characteristics of patients with major coronary artery anomalies.
- To determine the incidence and patterns of coronary atherosclerosis in patients with anomalous coronary arteries.
- To explore potential factors contributing to atherosclerosis in anomalous coronary vessels.
Main Methods:
- Retrospective review of 10,661 coronary angiograms.
- Identification and analysis of 94 patients with major coronary artery anomalies.
- Detailed clinical and angiographic data collection and assessment.
Main Results:
- Major coronary artery anomalies were identified in 83 patients from the primary cohort and 11 additional patients.
- The most frequent anomaly was the origin of the left circumflex coronary artery from the right coronary artery or right aortic sinus (38 patients).
- A high prevalence of significant coronary atherosclerosis (71%) was observed in the proximal portion of the anomalous left circumflex coronary artery, contrasting with prior research.
Conclusions:
- The origin of the left circumflex coronary artery from the right coronary artery or right aortic sinus is the most common anomaly in this cohort.
- The posterior course of this anomalous vessel may increase its susceptibility to atherosclerosis.
- A significant overall incidence of atherosclerotic disease (68%) was noted in the coronary arteries of patients with anomalies.
Abstract:
We reviewed the records of 10,661 patients who had undergone coronary angiography at the Clayton Foundation Cardiovascular Laboratories between 1 June 1974 and 15 March 1986, and identified major coronary artery anomalies in 83 adults. In addition, we included in our review 9 adults and 2 adolescents who had been referred for evaluation of anomalies documented elsewhere. Here we present the clinical and angiographic data for all 94 patients (76 men and 18 women). Most patients were men who presented with chest pain. The most common anomaly, found in 38 patients, was origin of left circumflex coronary artery from right coronary artery or right aortic sinus. In contrast to other studies, which have not shown increased incidence of coronary atherosclerosis in the anomalous circumflex artery, 71% of our patients with this anomaly had significant coronary atherosclerosis in the proximal portion of the anomalous vessel. The posterior course of the anomalous circumflex coronary artery may predispose this vessel to atherosclerosis in patients with coronary disease. The overall incidence of atherosclerotic disease in coronary arteries was 68% (64 of 94 patients) in the present study.
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