Robert Layser MD, Presenter: Nothing to Disclose

Michael Savage MD, Abstract Co-Author: Nothing to Disclose

Ethan J. Halpern MD, Abstract Co-Author: Nothing to Disclose

An anomalous coronary artery with an interarterial “malignant” course (IAC) is a recognized cause of sudden death in children and young adults. Coronary bypass grafting (CABG) is often recommended, especially for a left coronary IAC. However, the largest published review evaluated 54 subjects with an IAC and failed to demonstrate a long-term benefit from CABG (Krasuki et al. Circulation 2011;123(2):154-62). Given the increasing number of older adults with an IAC seen on coronary CT angiography (cCTA), we evaluated the association of IAC +/- CABG with subsequent cardiac events in adults over age 40.

Retrospective review of cCTA & conventional arteriograms from our institution identified 155 patients (ages 40-91, mean 64.5 years) with an anomalous coronary artery origin from the opposite coronary sinus, including 70 patients with an IAC (mean age: 63 years). Chart review provided a mean follow-up time of 5 years. Outcome data was evaluated for hard outcomes (myocardial infarction or cardiac death) and soft outcomes (persistent angina).

Although the severity of coronary disease as assessed by the number of vessels with >50% stenosis was lower among patients with vs without an IAC (0.86 vs 1.07 diseased vessels per patient, chi square for trend: p=0.3), the frequency of CABG was higher among those with an IAC (21/70) 30% vs without an IAC (15/85) 17.6%. The frequency of hard outcomes was similar among those with an IAC (12/70) 17.1% vs those without an IAC (15/85) 17.6% (p=0.44). Among patients with an IAC, the frequency of hard outcomes was similar with CABG (4/21) 19% vs without CABG (8/49) 16.3% (p=0.74). The frequency of soft events among patients with an IAC was also similar with CABG (9/21) 42.9% vs without CABG (17/49) 34.7% (p=0.59). Extent of coronary disease was the only significant predictor of outcome on multivariate regression (presence of IAC, CABG and left vs right IAC were not significant, p>0.4).

The frequency of both hard and soft outcomes among adult patients with anomalous coronary arteries was not significantly related to the presence of an IAC or to the history of CABG. No benefit was documented from CABG in our patients with an IAC.

As an increasing number of older adults with an IAC are identified with cCTA, it is important to recognize that CABG does not have a proven benefit for the treatment of anomalous coronary arteries in the older adult patient.

Layser, R, Savage, M, Halpern, E, Anomalous Coronary Arteries: Analysis of Clinical Outcome Based upon Arterial Course and Surgical Intervention. Is Bypass Grafting Beneficial for an Older Adult with an Interarterial Coronary Course?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003267.html