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Prevalence and clinical significance of coronary artery variations: a systematic review with meta-analysis
George Triantafyllou1, Ioannis Paschopoulos1, Maria Piagkou1
1Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece.
Insights
Main coronary artery anomalies are rare in healthy populations, affecting 2.11% of individuals. Early identification of these coronary artery variations is crucial for preventing cardiac events.
Area of Science:
- Cardiovascular Anatomy
- Medical Imaging
- Public Health
Background:
- Coronary artery anomalies (CA) are variations in the origin and course of major coronary arteries.
- Class A variations, specifically main CA anomalies, are assessed in this study.
- Understanding their prevalence in healthy populations is vital for clinical relevance.
Purpose of the Study:
- To determine the prevalence of main coronary artery (CA) origin and course anomalies (class A variations) in healthy individuals.
- To assess the clinical relevance and potential association with ischemic events.
- To provide data for risk stratification and clinical decision-making.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA 2020 and Evidence-based Anatomy guidelines.
- Comprehensive literature search across major databases (PubMed, Google Scholar, Scopus, Web of Science).
- Statistical analysis using random-effects models in R, with subgroup, meta-regression, and leave-one-out analyses to address heterogeneity.
Main Results:
- Pooled prevalence of typical coronary artery anatomy was 97.89%; main CA anomalies occurred in 2.11% of subjects across 58 studies (503,171 individuals).
- Anomalous origin of the right coronary artery from the left sinus (0.30%) and high take-off right coronary artery (0.14%) were the most common variations.
- Higher prevalence noted in American populations and computed tomography-based studies; an increasing trend observed with later publication years.
Conclusions:
- Main coronary artery anomalies are uncommon but clinically significant, linked to ischemic events and sudden cardiac death.
- Variants with interarterial or intramural courses warrant particular attention.
- Early detection via modern imaging is critical for effective risk stratification and patient management.
Background:
This systematic review and meta-analysis aimed to determine the prevalence and clinical relevance of main coronary artery (CA) origin and course anomalies (class A variations) in healthy populations.
Methods:
This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Evidence-based Anatomy guidelines. A literature search was conducted across PubMed, Google Scholar, Scopus, and Web of Science. Statistical analysis was performed in R using random-effects models, with pooled prevalence calculated through the Freeman-Tukey transformation. Subgroup, meta-regression, and leave-one-out analyses were performed to explain the source of heterogeneity.
Results:
A total of 58 studies with 503,171 subjects were included. The pooled prevalence of typical CA anatomy was 97.89% (95% CI: 97.51-98.25), whereas main CA anomalies had a prevalence of 2.11% (95% CI: 1.82-2.70). Subgroup analysis retrieved statistically significant differences for nationality and study type, and meta-regression revealed an increasing trend of CA variants with later publication years. The most common variation was the anomalous origin of the right CA from the left sinus (0.30%), followed by a high take-off of the right CA (0.14%). Left CA anomalies were less frequent, with anomalous origin from the right sinus recorded in 0.05% of cases. Subgroup analyses revealed a higher prevalence in American populations and computed tomography-based studies.
Conclusions:
Main CA anomalies (class A variations) are rare but clinically significant owing to their association with ischemic events and sudden cardiac death, particularly variants with interarterial or intramural courses. Early identification through modern imaging is critical for risk stratification and clinical decision-making.
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