Anomalous origin of culprit coronary arteries in acute coronary syndromes

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Imaging

Background:

• Acute coronary syndrome (ACS) can arise from anomalous coronary artery origins.
• Anomalous origin of culprit coronary artery (AOCCA) is infrequently diagnosed in ACS patients.
• Percutaneous coronary intervention (PCI) for AOCCA is challenging and rarely performed.

Purpose of the Study:

• To describe a series of ACS patients diagnosed with AOCCA.
• To analyze the types and management of AOCCA in ACS.
• To highlight the diagnostic and interventional difficulties associated with AOCCA.

Main Methods:

• Retrospective search of electronic databases from three high-volume tertiary cardiac centers.
• Identification and classification of AOCCA in ACS patients.
• Review of percutaneous coronary intervention (PCI) outcomes and management strategies.

Main Results:

• Twenty ACS patients with AOCCA were identified.
• The most frequent AOCCA was the left circumflex coronary artery (LCx) originating from the right coronary artery (RCA) or right coronary sinus (RCS) (n=13).
• PCI was successfully performed in most cases, but challenges included failed cannulation in STEMI and missed diagnoses, particularly when anatomy mimicked typical coronary artery branching.

Conclusions:

• The LCx artery originating from the RCA is the most common AOCCA in ACS.
• AOCCA can present diagnostic and interventional challenges, including difficulty in cannulation and potential for missed diagnosis.
• Successful PCI is achievable but requires careful consideration of anomalous anatomy.