Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris.
Department of interventional cardiology, Pôle Cardiovasculaire Interventionnel, Clinique les Fontaines, Melun.
Coron Artery Dis. 2024 Dec 1;35(8):633-640. doi: 10.1097/MCA.0000000000001385. Epub 2024 May 15.
The prevalence and location of coronary artery disease (CAD) in anomalous aortic origin of a coronary artery (AAOCA) remain poorly documented in adults. We sought to assess the presence of CAD in proximal (or ectopic) and distal (or nonectopic) segments of AAOCA. We hypothesized that the representation of CAD may differ among the different courses of AAOCA.
The presence of CAD was analyzed on coronary angiography and/or coronary computed tomography angiography in 390 patients (median age 64 years; 73% male) with AAOCA included in the anomalous coronary arteries multicentric registry.
AAOCA mainly involved circumflex artery (54.4%) and right coronary artery (RCA) (31.3%). All circumflex arteries had a retroaortic course; RCA mostly an interarterial course (98.4%). No CAD was found in the proximal segment of interarterial AAOCA, whereas 43.8% of retroaortic AAOCA, 28% of prepulmonic AAOCA and 20.8% subpulmonic AAOCA had CAD in their proximal segments ( P < 0.001). CAD was more prevalent in proximal than in distal segments of retroaortic AAOCA (OR: 3.1, 95% CI: 1.8-5.4, P < 0.001). On multivariate analysis, a retroaortic course was associated with an increased prevalence of CAD in the proximal segment (adjusted OR 3.4, 95% CI: 1.3-10.7, P = 0.022).
Increased prevalence of CAD was found in the proximal segment of retroaortic AAOCA compared to the proximal segments of other AAOCA, whereas no CAD was observed in the proximal segment of interarterial AAOCA. The mechanisms underlying these differences are not yet clearly identified.
在冠状动脉异常起源（AAOCA）的成人中，冠状动脉疾病（CAD）的患病率和位置仍记录不佳。我们试图评估 AAOCA 的近端（或异位）和远端（或非异位）节段是否存在 CAD。我们假设 CAD 的表现可能因 AAOCA 的不同途径而有所不同。
在异常冠状动脉多中心注册中心纳入的 390 例 AAOCA 患者（中位年龄 64 岁；73%为男性）的冠状动脉造影和/或冠状动脉计算机断层血管造影分析 CAD 的存在。
AAOCA 主要累及回旋支（54.4%）和右冠状动脉（RCA）（31.3%）。所有回旋支均有主动脉后走行；RCA 主要有动脉间走行（98.4%）。在动脉间 AAOCA 的近端节段未发现 CAD，而在主动脉后 AAOCA 的近端节段有 43.8%、肺动脉前 AAOCA 的近端节段有 28%、肺动脉后 AAOCA 的近端节段有 20.8%存在 CAD（P<0.001）。主动脉后 AAOCA 的近端节段 CAD 的患病率高于远端节段（OR：3.1，95%CI：1.8-5.4，P<0.001）。多变量分析显示，主动脉后走行与近端节段 CAD 的患病率增加相关（校正 OR 3.4，95%CI：1.3-10.7，P=0.022）。
与其他 AAOCA 的近端节段相比，主动脉后 AAOCA 的近端节段 CAD 的患病率增加，而动脉间 AAOCA 的近端节段未发现 CAD。这些差异的潜在机制尚不清楚。
