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European heart journal cardiovascular Imaging v.18 no.2, 2017년, pp.224 - 235   SCIE
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Anomalous origin of the coronary artery arising from the opposite sinus: prevalence and outcomes in patients undergoing coronary CTA

Cheezum, Michael K. (Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ) ; Ghoshhajra, Brian (Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA ) ; Bittencourt, Marcio S. (Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ) ; Hulten, Edward A. (Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ) ; Bhatt, Ami (Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA ) ; Mousavi, Negareh (Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ) ; Shah, Nishant R. (Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ) ; Valente, Anne Marie (Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA ) ; Rybicki, Frank J. (Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ) ; Steigner, Michael (Department of Radiology, Brigham and Women's Hospital ) ; Hainer, Jon ; MacGillivray, Thomas ; Hoffmann, Udo ; Abbara, Suhny ; Di Carli, Marcelo F. ; DeFaria Yeh, Doreen ; Landzberg, Michael ; Liberthson, Richard ; Blankstein, Ron ;
  • 초록  

    Aims 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. Methods and results 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. Conclusion 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.


  • 주제어

    anomalous coronary artery .   coronary computed tomographic angiography .   prognosis .   revascularization .   sudden cardiac death.  

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