Procedural characteristics of coronary angiography in patients with anomalous aortic origin of a coronary artery.

Abstract

Background: Anomalous coronary arteries (ACA) are seen in 1-5 % of patients undergoing coronary angiography, and their presence may increase procedural difficulty. We aimed to compare procedural outcomes of coronary angiography in ACA patients by anatomy and prior knowledge of the ACA.

Methods: This was a single-center review of ACA patients undergoing coronary angiography between October 2013 and February 2022. Primary endpoints were contrast volume, fluoroscopy dose, time, and dose-area product (DAP). Comparisons were made between groups based on ACA anatomy and based on prior knowledge of the ACA.

Results: We found 176 diagnostic coronary angiograms among ACA patients. Anomalies of the right coronary artery (RCA) comprised 77 %, followed by left circumflex (LCX) at 16 % and left main or left anterior descending (LMCA/LAD) at 7 %. There was significantly more contrast use among patients with RCA (mean 110.5 mL) or LMCA/LAD (115.6 mL) anomalies than LCX (76.2 mL; p = 0.01). There was no difference in fluoroscopy dose, time, or DAP. Prior knowledge of the anomaly was recorded in 61 (35 %) cases. Contrast volume (mean difference 27.1 mL, 95 % confidence interval: 12.5-41.8) and all fluoroscopy measures decreased if the ACA was previously known to the operators.

Conclusion: Different types of ACAs are associated with increased contrast use but not fluoroscopy exposure. Prior knowledge of ACA is associated with decreased contrast use and fluoroscopy exposure. Thorough review of prior catheterizations and knowledge of catheter selection is important for reducing contrast use and fluoroscopy exposure in patients with ACA.