Ghadri Jelena R, Kazakauskaite Egle, Braunschweig Stefanie, Burger Irene A, Frank Michelle, Fiechter Michael, Gebhard Catherine, Fuchs Tobias A, Templin Christian, Gaemperli Oliver, Lüscher Thomas F, Schmied Christian, Kaufmann Philipp A
Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
BMC Cardiovasc Disord. 2014 Jul 8;14:81. doi: 10.1186/1471-2261-14-81.
As coronary computed tomography angiography (CCTA) has emerged as a non-invasive alternative for evaluation of coronary anatomy with a lower referral threshold than invasive coronary angiography (ICA), the prevalence of coronary anomalies in CCTA may more closely reflect the true prevalence in the general population. Morphological features of coronary anomalies can be evaluated more precisely by CCTA than by ICA, which might lead to a higher identification of congenital coronary anomalies in CCTA compared to ICA.To evaluate the incidence, clinical and morphological features of the anatomy of patients with coronary anomalies detected either by coronary computed tomography angiography (CCTA) with prospective ECG-triggering or invasive coronary angiography (ICA).
Consecutive patients underwent 64-slice CCTA (n = 1'759) with prospective ECG-triggering or ICA (n = 9'782) and coronary anatomy was evaluated for identification of coronary anomalies to predefined criteria (origin, course and termination) according to international recommendations.
The prevalence of coronary anomalies was 7.9% (n = 138) in CCTA and 2.1% in ICA (n = 203; p < 0.01). The most commonly coronary anomaly detected by CCTA was myocardial bridging 42.8% (n = 59) vs. 21.2% (n = 43); p < 0.01, while with ICA an absent left main trunk was the most observed anomaly 36.0% (n = 73; p < 0.01). In 9.4% (n = 13) of identified coronary anomalies in CCTA 9.4% were potentially serious coronary anaomalies, defined as a course of the coronary artery between aorta and pulmonary artery were identified.
The prevalence of coronary anomalies is substantially higher with CCTA than ICA even after exclusion of patients with myocardial bridging which is more frequently found with CCTA. This suggests that the true prevalence of coronary anomalies in the general population may have been underestimated based on ICA.
由于冠状动脉计算机断层扫描血管造影（CCTA）已成为评估冠状动脉解剖结构的一种非侵入性替代方法，其转诊阈值低于侵入性冠状动脉造影（ICA），CCTA中冠状动脉异常的患病率可能更能准确反映普通人群中的真实患病率。与ICA相比，CCTA能够更精确地评估冠状动脉异常的形态特征，这可能导致CCTA比ICA能更高比例地识别出先天性冠状动脉异常。为了评估通过前瞻性心电图触发的冠状动脉计算机断层扫描血管造影（CCTA）或侵入性冠状动脉造影（ICA）检测出的冠状动脉异常患者的解剖结构的发生率、临床及形态学特征。
连续纳入患者，其中1759例接受了前瞻性心电图触发的64层CCTA检查，9782例接受了ICA检查，并根据国际推荐标准，对冠状动脉解剖结构进行评估，以确定是否存在符合预定义标准（起源、走行和终止）的冠状动脉异常。
CCTA中冠状动脉异常的患病率为7.9%（n = 138），ICA中为2.1%（n = 203；p < 0.01）。CCTA检测到的最常见冠状动脉异常是心肌桥，占42.8%（n = 59），而ICA中为21.2%（n = 43）；p < 0.01，而在ICA中，左主干缺如是最常见的异常，占36.0%（n = 73；p < 0.01）。在CCTA中识别出的冠状动脉异常中，9.4%（n = 13）为潜在的严重冠状动脉异常，定义为发现冠状动脉在主动脉和肺动脉之间走行。
即使排除了CCTA中更常见的心肌桥患者，CCTA中冠状动脉异常的患病率仍显著高于ICA。这表明基于ICA，普通人群中冠状动脉异常的真实患病率可能被低估了。
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