Association Between Coronary Artery Anomalies, Obstructive Coronary Disease, and Procedural Complexity During...

The clinical and procedural implications of coronary artery anomalies (CAAs) remain incompletely defined.

To evaluate the association between anomalous coronary anatomy, obstructive coronary artery disease (CAD), and procedural complexity during coronary angiography and percutaneous coronary intervention (PCI).

In this retrospective single-center study, all patients who underwent coronary angiography between 2014 and 2025 were screened. Among 9567 angiograms, 134 patients (1.4%) had CAAs of origin/course or termination (excluding myocardial bridges). A vessel-level data set was constructed, and obstructive CAD (≥ 50% stenosis) was compared between anomalous and non-anomalous arteries using clustered logistic regression. Fluoroscopy time, contrast volume, catheter selection, and selective cannulation success were evaluated using multivariable and descriptive analyses.

Of the 134 cases, 53 were anomalies of origin (52 from the aorta and 1 from the pulmonary artery), 51 were variants of origin (28 separate LAD and LCx ostia, 21 anterior RCA take-offs, and 2 high take-offs of the left coronary artery), and 30 were anomalies of termination (27 coronary-pulmonary artery fistulas, 1 coronary-cardiac chamber fistula, and 2 coronary-venous fistulas). Obstructive CAD was more frequent in anomalous versus non-anomalous arteries (33.9% vs. 24.2%) and remained independently associated with anomalous anatomy (OR 1.61, 95% CI 1.15-2.26; p = 0.006). Catheterization of anomalies of origin was independently associated with longer fluoroscopy time (+3.72 min; p = 0.0015) and higher contrast use (+49.6 mL; p = 0.004). PCI involving anomalous arteries required longer fluoroscopy time compared with PCI of non-anomalous vessels (median 14.6 vs. 8.4 min; p = 0.033).

Anomalous coronary arteries are associated with increased vessel-level prevalence of obstructive CAD and greater procedural complexity, particularly in anomalies of origin.