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Anomalies of coronary artery origin at invasive angiography: a prospective study of prevalence, catheter utilisation,
Qayoom Yousuf1, Aamir Rashid2, Sameer Purra2
1Department of Cardiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India. qayoomyousufbhat@gmail.com.
Insights
Coronary artery anomalies present unique challenges in invasive coronary angiography. Patients with these anomalies require more catheters and experience higher rates of access crossover and guide catheter changes, though major complications remain similar.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Coronary artery anomalies are uncommon congenital heart defects.
- These anomalies can complicate selective engagement during invasive coronary angiography (CAG).
- Limited prospective data exists on current radial-first practice for managing these anomalies.
Purpose of the Study:
- To prospectively evaluate diagnostic and guide catheter utilization in patients with coronary artery anomalies.
- To assess procedural implications and access strategies in current radial-first practice.
- To compare outcomes between patients with and without coronary artery anomalies.
Main Methods:
- Prospective enrollment of 1,850 adult patients undergoing invasive CAG.
- Classification of anomalies using the modified Angelini classification (excluding intrinsic and termination anomalies).
- Comparison of baseline, angiographic, and procedural data, including catheter use and access strategy, between anomaly and non-anomaly groups.
Main Results:
- Anomalies of origin were identified in 4.59% of patients.
- Ectopic right coronary artery origin was the most common anomaly (55.3%).
- Anomaly patients required more diagnostic catheters (2.20 vs. 1.23), experienced more access crossovers (16.5% vs. 5.0%), and more guide catheter changes (44.2% vs. 6.5%) compared to non-anomaly patients (p < 0.001).
- No significant difference in major procedural complications was observed (4.7% vs. 2.7%; p = 0.43).
Conclusions:
- Coronary artery anomalies necessitate increased diagnostic and guide catheter use during invasive procedures.
- Radial access strategies require adaptation for anomaly patients, with a higher rate of crossover to femoral access.
- Despite increased procedural complexity, major complication rates were similar between groups in this study.
Background:
Anomalies of coronary artery origin are uncommon congenital variants that may pose a challenge to selective engagement at invasive coronary angiography (CAG). Although their prevalence and anatomical spectrum are well described, prospective data on the diagnostic and guide catheter utilisation to engage each anomaly subtype, procedural implications and on the access strategy adopted in current radial-first practice, remain limited.
Methods:
We prospectively enrolled 1,850 consecutive adults undergoing invasive CAG, with or without percutaneous coronary intervention (PCI). Anomalies of origin were defined by the modified Angelini classification; intrinsic anomalies and anomalies of termination were excluded. Baseline, angiographic, procedural data - including diagnostic and guide catheter use by subtype; and access strategy were compared between anomaly and non-anomaly groups.
Results:
An anomaly of origin was identified in 85 of 1,850 patients (4.59%; 95% CI 3.71-5.63%); under a restricted definition that excluded two anatomical variants not consistently classified as anomalies in earlier invasive-angiography series, prevalence was 1.30% (95% CI 0.83-1.92%). The commonest anomaly was ectopic (high or anterior) right coronary artery (RCA) origin from the right coronary cusp (n = 47; 55.3%), followed by separate ostia of left anterior descending (LAD) and left circumflex (LCx) arteries (n = 14; 16.5%) and anomalous LCx from the right coronary cusp or RCA (n = 14; 16.5%). PCI was performed in 52 of 85 anomaly patients (61.2%). Radial access was attempted in 67 patients: 53 (79.1%) completed radially, 14 (20.9%) required crossover to femoral; and 18 were attempted femorally. Anomaly patients required more diagnostic catheters per case (2.20 vs. 1.23), with the greatest burden in crossover cases (3.14 vs. 1.17 catheters); more access crossover (16.5% vs. 5.0%) and more guide catheter changes (44.2% vs. 6.5%; all p < 0.001),. No significant difference in major procedural complications was observed (4.7% vs. 2.7%; p = 0.43); however the study was not powered for rare procedural events.
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