Cheezum Michael K, Ghoshhajra Brian, Bittencourt Marcio S, Hulten Edward A, Bhatt Ami, Mousavi Negareh, Shah Nishant R, Valente Anne Marie, Rybicki Frank J, Steigner Michael, Hainer Jon, MacGillivray Thomas, Hoffmann Udo, Abbara Suhny, Di Carli Marcelo F, DeFaria Yeh Doreen, Landzberg Michael, Liberthson Richard, Blankstein Ron
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA.
Eur Heart J Cardiovasc Imaging. 2017 Feb;18(2):224-235. doi: 10.1093/ehjci/jev323. Epub 2016 Feb 3.
The impact of coronary computed tomographic angiography (CTA) on management of anomalous origin of the coronary artery arising from the opposite sinus (ACAOS) remains uncertain. We examined the prevalence, anatomical characterization, and outcomes of ACAOS patients undergoing CTA.
Among 5991 patients referred for CTA at two tertiary hospitals between January 2004 and June 2014, we identified 103 patients (1.7% prevalence) with 110 ACAOS vessels. Mean age was 52 years (range 5-83, 63% male), with 55% previously known ACAOS and 45% discovered on CTA. ACAOS subtypes included: 39% interarterial (n = 40 anomalous right coronary artery, n = 3 anomalous left coronary artery), 38% retroaortic, 15% subpulmonic, 5% prepulmonic, and 2% other. ACAOS patients were assessed for symptoms, ischaemic test results, revascularization, all-cause or cardiovascular (CV) death, and myocardial infarction. CTAs were reviewed for ACAOS course, take-off height and angle, length and severity of proximal narrowing, intramural course, and obstructive coronary artery disease (CAD). In follow-up (median 5.8 years), there were 20 surgical revascularizations and 3 CV deaths. After adjusting for obstructive CAD (n = 21/103, 20%), variables associated with ACAOS revascularization included the following: CV symptoms, proximal vessel narrowing ≥50%, length of narrowing >5.4 mm, and an interarterial course.
The prevalence of ACAOS on CTA was 1.7%, including 45% of cases discovered incidentally. CTA provided excellent characterization of ACAOS features associated with coronary revascularization, including the length and severity of proximal vessel narrowing.
冠状动脉计算机断层血管造影（CTA）对起源于对侧窦的冠状动脉异常起源（ACAOS）的管理影响仍不确定。我们研究了接受CTA检查的ACAOS患者的患病率、解剖特征和结局。
在2004年1月至2014年6月期间于两家三级医院接受CTA检查的5991例患者中，我们识别出103例患者（患病率为1.7%），共110条ACAOS血管。平均年龄为52岁（范围5 - 83岁，男性占63%），其中55%的患者之前已知患有ACAOS，45%是通过CTA发现的。ACAOS亚型包括：39%为动脉间型（n = 40例异常右冠状动脉，n = 3例异常左冠状动脉），38%为主动脉后型，15%为肺动脉下型，5%为肺动脉前型，2%为其他类型。对ACAOS患者进行了症状、缺血试验结果、血运重建、全因或心血管（CV）死亡以及心肌梗死方面的评估。对CTA进行了回顾，以了解ACAOS的走行、起始高度和角度、近端狭窄的长度和严重程度、壁内走行以及阻塞性冠状动脉疾病（CAD）情况。在随访（中位时间5.8年）期间，有20例接受了外科血运重建，3例发生CV死亡。在对阻塞性CAD（n = 21/103，20%）进行校正后，与ACAOS血运重建相关的变量包括：CV症状、近端血管狭窄≥50%、狭窄长度>5.4 mm以及动脉间走行。
CTA上ACAOS的患病率为1.7%，其中45%的病例为偶然发现。CTA能很好地显示与冠状动脉血运重建相关的ACAOS特征，包括近端血管狭窄的长度和严重程度。
