Clinical and Prognostic Significance of Anomalous Origin of a Coronary Artery in Adults
Francesco Gentile1,2, Eliana Carapellucci2, Vincenzo Uggenti3
1Health Science Interdisciplinary Center (F.G., C.P., A.G., M.E.), Scuola Superiore Sant'Anna, Pisa, Italy.
Insights
Anomalous aortic origin of a coronary artery (AAOCA) in adults does not increase mortality or major adverse cardiac events. Obstructive coronary disease, not AAOCA itself, predicts adverse outcomes, necessitating multicenter studies for better risk stratification.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- The clinical significance of anomalous aortic origin of a coronary artery (AAOCA) in adults is not well-defined.
- Predictors of outcomes in adult AAOCA patients require further investigation.
Purpose of the Study:
- To analyze the clinical and prognostic implications of AAOCA in a large adult cohort.
- To identify outcome predictors in adult patients with AAOCA.
Main Methods:
- Retrospective analysis of consecutive adults with AAOCA identified via coronary computed tomography angiography (CCTA) over 20 years.
- Data collection included CCTA indications, AAOCA subtypes, myocardial ischemia, and coronary atherosclerotic disease.
- Outcomes (mortality, major adverse cardiac events) compared with matched controls.
Main Results:
- AAOCA was detected in 173 adults (mean age 62 years); chest pain was the most common indication for CCTA.
- Obstructive coronary atherosclerotic disease was present in 21% of AAOCA patients; 60% of those tested showed ischemia.
- No significant difference in mortality or major adverse cardiac events between AAOCA patients and controls.
Conclusions:
- Obstructive coronary atherosclerotic disease, not AAOCA subtype or ischemia, is the primary determinant of adverse events in adults.
- Low prevalence and event rates highlight the need for multicenter registries to refine risk stratification and management for AAOCA.
Background:
The clinical significance and outcome predictors of anomalous aortic origin of a coronary artery (AAOCA) in adults remains unclear. Therefore, the aim of this study was to analyze the clinical and prognostic implications of AAOCA in a large cohort of patients undergoing coronary computed tomography angiography (CCTA) in an Italian tertiary referral center.
Methods:
Consecutive adults with AAOCA identified through CCTA from September 2004 to September 2024 were included. Data on clinical indications of CCTA, AAOCA subtypes, evidence of inducible myocardial ischemia, and concomitant coronary atherosclerotic disease were collected. Patients were followed up for the end points of all-cause mortality and major adverse cardiac events (nonfatal acute coronary syndromes, revascularization procedures, and heart failure hospitalization). Outcomes were compared with matched controls with normal coronary artery anatomy.
Results:
Among 17 454 CCTAs performed over a span of 20 years, AAOCA was detected in 173 patients (62±15 years of age, n=58 women [34%]). Chest pain (34%) was the most common indication of CCTA. Obstructive coronary atherosclerotic disease was present in 36 patients (21%), and myocardial ischemia was detected in 60% of those (n=62) who underwent functional imaging testing. AAOCA repair was performed in 9 patients (5%), whereas the majority of patients were treated conservatively. After a median 37-month follow-up (17 to 69 months), mortality (P=0.321) and major adverse cardiac events (P=0.392) were similar between patients with AAOCA and controls. Only obstructive coronary atherosclerotic disease was associated with a higher event rate during follow-up, whereas AAOCA subtype and ischemia were not.
Conclusions:
In adults with AAOCA, concomitant obstructive coronary atherosclerotic disease is the primary determinant of adverse events. Given the low prevalence of AAOCA and event rates, multicenter registries are needed to refine risk stratification and management of these patients.
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