Outcomes in Anomalous Aortic Origin of a Coronary Artery Following a Prospective Standardized Approach
Silvana Molossi1, Hitesh Agrawal2, Carlos M Mery3
1Coronary Anomalies Program, The Lillie Frank Abercrombie Section of Pediatric Cardiology (S.M., P.M., S.K.S.T., A.M.Q., S.P.J., E.D.M.), Texas Children's Hospital, Baylor College of Medicine, Houston.
Insights
Anomalous aortic origin of a coronary artery (CA) is a concern in young athletes. Most patients in this study, managed by a multidisciplinary team, were cleared for unrestricted sports, indicating favorable outcomes.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Sports Cardiology
Background:
- Anomalous aortic origin of a coronary artery (CA) is a significant cause of sudden cardiac death in young athletes.
- Current management strategies and long-term outcomes for anomalous CA remain incompletely understood, necessitating further research.
Purpose of the Study:
- To prospectively evaluate the outcomes of patients diagnosed with anomalous aortic origin of a CA.
- To assess the effectiveness of a standardized diagnostic and management algorithm in risk stratification and determining exercise eligibility.
Main Methods:
- A prospective cohort study followed patients with anomalous aortic origin of a CA from December 2012 to April 2017.
- Patients underwent evaluation using a standardized algorithm, including stress imaging for myocardial perfusion assessment.
- High-risk criteria included specific anatomical features, symptoms, or evidence of ischemia; management decisions were made by a multidisciplinary team.
Main Results:
- Of 163 eligible patients, 82% were deemed high risk based on specific criteria.
- Older age, black race, intramural course, and exertional syncope were predictors of high risk.
- The majority of patients (82%) were cleared for unrestricted sports activities, with only 6.4% facing restrictions post-intervention.
Conclusions:
- Most patients with anomalous aortic origin of a CA can safely participate in unrestricted sports activities.
- A multidisciplinary team approach facilitates consistent management and aids in risk stratification for improved long-term prognosis.
Background:
Anomalous aortic origin of a coronary artery (CA) is the second leading cause of sudden cardiac death in young athletes. Management is controversial and longitudinal follow-up data are sparse. We aim to evaluate outcomes in a prospective study of anomalous aortic origin of CA patients following a standardized algorithm.
Methods:
Patients with anomalous aortic origin of a CA were followed prospectively from December 2012 to April 2017. All patients were evaluated following a standardized algorithm, and data were reviewed by a dedicated multidisciplinary team. Assessment of myocardial perfusion was performed using stress imaging. High-risk patients (high-risk anatomy-anomalous left CA from the opposite sinus, presence of intramurality, abnormal ostium-and symptoms or evidence of myocardial ischemia) were offered surgery or exercise restriction (if deemed high risk for surgical intervention). Univariate and multivariable analyses were used to determine predictors of high risk.
Results:
Of 201 patients evaluated, 163 met inclusion criteria: 116 anomalous right CA (71%), 25 anomalous left CA (15%), 17 single CA (10%), and 5 anomalous circumflex CA (3%). Patients presented as an incidental finding (n=80, 49%), with exertional (n=31, 21%) and nonexertional (n=32, 20%) symptoms and following sudden cardiac arrest/shock (n=5, 3%). Eighty-two patients (50.3%) were considered high risk. Predictors of high risk were older age at diagnosis, black race, intramural course, and exertional syncope. Most patients (82%) are allowed unrestrictive sports activities. Forty-seven patients had surgery (11 anomalous left CA and 36 anomalous right CA), 3 (6.4%) remained restricted from sports activities. All patients are alive at a median follow-up of 1.6 (interquartile range, 0.7-2.8) years.
Conclusions:
In this prospective cohort of patients with anomalous aortic origin of a CA, most have remained free of exercise restrictions. Development of a multidisciplinary team has allowed a consistent approach and may have implications in risk stratification and long-term prognosis.
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