Coronary artery anomalies in computed tomography of coronary arteries for symptomatic patients: Types, prevalence and association with atheromatous disease.

INTRODUCTION Anomalous coronary arteries are rare but potentially dangerous. Early diagnosis and recognition can prevent serious outcomes. Our study aimed to determine the prevalence of coronary artery anomalies amongst symptomatic individuals who presented for computer tomography of coronary arteries (CTCA) and their trends with age and concurrent atherosclerotic disease.

Methods

Retrospective study of all CTCAs for symptomatic patients was conducted over a 5-year period in a large healthcare network, including a dedicated heart hospital, to identify the types and prevalence of anomalous coronary arteries. Patients' age, symptomology and associated atherosclerotic burden represented by CAD-RADS and calcium scores were compared between the identified individuals with coronary artery anomalies.

Results

A total of 13,596 patients were recruited. 296 (2.18%) patients had significant coronary anomalies. Mean age was 53.85 years. 211/296 (71.28%) patients had anomalous coronary artery origins. 180/296 (60.81%) patients had anomalous coronary artery courses in which 85/180 (47.22%) were potentially malignant (inter-arterial course). There were 25/296 (8.45%) patients with coronary artery fistulae and 12/296 (4.05%) patients with more complex coronary vascular malformations. There was statistical significance between potentially malignant coronary artery course and younger age and trend towards lower CAD-RADS score and Agatston calcium score.

Conclusion

Broad variability of incidence of coronary anomalies on imaging has been reported in the literature. To our knowledge, this study is amongst the first to demonstrate a statistically significant association between potentially malignant coronary artery course and younger age on CTCA, with a trend towards lower CAD-RADS score and Agatston calcium score also observed.