Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
Department of Cardiology, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
Eur Heart J. 2017 Jul 1;38(25):2009-2016. doi: 10.1093/eurheartj/ehx046.
Anomalous origin of a coronary artery from the opposite sinus (ACAOS) has been associated with adverse cardiac events in the young. It remains unknown whether this holds true for middle-aged patients with uncorrected ACAOS as well. We assessed the outcome in middle-aged patients with newly diagnosed ACAOS by coronary computed tomography angiography (CCTA) compared with a matched cohort.
We retrospectively identified 68 consecutive patients with ACAOS documented by CCTA. ACAOS with a course of the anomalous vessel between the aorta and pulmonary artery were classified as interarterial course (IAC). Each patient with ACAOS was matched to two controls without ACAOS. Major adverse cardiac events (i.e. myocardial infarction, revascularization and cardiac death) were recorded for all patients and controls. Two (3%) patients were lost to follow-up. Thus, 66 patients with ACAOS were included in the final analysis and matched with 132 controls. Mean age of patients was 56 ± 11 years, 73% were male and the mean follow-up was 49 months. Forty (65%) patients were classified as having ACAOS with IAC. The annual event rate of ACAOS vs. controls was 4.9 and 4.8%, the hazard ratio (HR) 0.94 (0.39-2.28, P = 0.89). The annual event rate of ACAOS with IAC compared with their matched controls was 5.2 and 4.3%, and the HR 1.01 (95% CI 0.39-2.58, P = 0.99).
In middle-aged individuals with newly diagnosed ACAOS mid-term outcome is not statistically different to a matched control cohort without coronary artery anomalies, regardless of whether ACAOS with or without IAC variants are present.
起源异常的冠状动脉（ACAOS）与年轻人的不良心脏事件有关。目前尚不清楚未经矫正的 ACAOS 中年患者是否也存在这种情况。我们通过冠状动脉计算机断层血管造影（CCTA）评估了新诊断为 ACAOS 的中年患者的结局，并与匹配队列进行了比较。
我们回顾性地确定了 68 例经 CCTA 证实的 ACAOS 连续患者。将异常血管在主动脉和肺动脉之间走行的 ACAOS 分类为动脉间型（IAC）。每例 ACAOS 患者均与 2 例无 ACAOS 的对照匹配。记录所有患者和对照的主要不良心脏事件（即心肌梗死、血运重建和心脏死亡）。有 2 例（3%）患者失访。因此，66 例 ACAOS 患者纳入最终分析，并与 132 例对照匹配。患者的平均年龄为 56±11 岁，73%为男性，平均随访时间为 49 个月。40 例（65%）患者被归类为 IAC 型 ACAOS。ACAOS 与对照组的年事件发生率分别为 4.9%和 4.8%，风险比（HR）为 0.94（0.39-2.28，P=0.89）。与匹配对照相比，IAC 型 ACAOS 的年事件发生率为 5.2%和 4.3%，HR 为 1.01（95%CI 0.39-2.58，P=0.99）。
在新诊断为 ACAOS 的中年患者中，中期结局与无冠状动脉异常的匹配对照组在统计学上没有差异，无论是否存在伴有或不伴有 IAC 变异的 ACAOS。
