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The first multicentre study on coronary anomalies in the Netherlands: MuSCAT

C J Koppel1, B W Driesen2, R J de Winter3

  • 1Department of Cardiology, CAHAL, Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Centre, Leiden, The Netherlands.

Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
|March 8, 2021
PubMed

Insights

This study establishes a structured pathway for diagnosing and treating anomalous coronary arteries, particularly those with an interarterial course. It aims to provide evidence-based recommendations for managing these complex cardiac conditions.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Interventional Cardiology

Background:

  • Current guidelines for coronary anomalies lack a diagnostic gold standard and consensus on treatment strategies.
  • Patients with anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) with an interarterial course present particular management challenges.

Purpose of the Study:

  • To develop evidence-substantiated recommendations for the diagnostic work-up, treatment, and follow-up of patients with anomalous coronary arteries.
  • To establish a structured, multicenter clinical care pathway for managing ACAOS.

Main Methods:

  • A prospective, multicenter study involving six Dutch centers established a clinical care pathway for ACAOS.
  • Patients undergo comprehensive work-up including CT angiography, ischemia detection, echocardiography, and coronary angiography with intracoronary measurements.
  • Follow-up includes CT angiography, ischemia detection, and quality-of-life questionnaires; a registry is maintained for other coronary anomalies.

Main Results:

  • Primary outcomes include cardiac death, ACAOS-attributable myocardial ischemia, and re-intervention rates.
  • The study evaluates the impact of diagnostic examinations on treatment choices.
  • Long-term follow-up data will be collected to assess outcomes.

Conclusions:

  • There is a lack of robust evidence for managing coronary anomalies, especially interarterial ACAOS.
  • A structured, multicenter care pathway is being implemented to provide an evidence-based strategy for diagnosis and treatment.
  • This approach aims to improve the management of patients with anomalous coronary arteries.
Abstract

Keywords:
Anomalous coronary artery from the opposite sinus of ValsalvaAnomalous coronary artery from the pulmonary arteryCoronary anomaliesCoronary arteriovenous fistulaMulticentre study

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