Prevalence of coronary artery anomalies and arising complications during catheter guided angiography

Abstract

Background: Coronary artery anomalies (CAA) refer to very uncommon and unusual morphological features of the epicardial coronary artery that account for 1/5th of deaths in athletes. Patients with CAA are also prone to develop significant coronary artery disease. Identification of such arteries during catheter-guided angiography is very challenging and associated with many devastating complications like arrhythmia, heart failure, contrast-induced nephropathy, bleeding, cardio-embolic events, mechanical injury to the coronary artery, etc. Objective: To describe the prevalence of various types of coronary anomalies and the complications, that arise during catheter-guided angiography. Materials and method: A total of 2849 patients who underwent angiography (for angina or angina equivalents) at the catheterization laboratory, VIMSAR, Burla, were enrolled in the study. Angiographic records and videos of patients were noted. Coronary anomalies were detected as per quantitative and qualitative criteria provided by the American Heart Association in 2007. The anomalous coronary arteries were classified into three groups based on the guidelines: Group A—anomalies of origin and course; Group B—anomalies of intrinsic coronary arterial anatomy; and Group C—anomalies of coronary termination. Data with respect to baseline characteristics and complications are collected, compiled, and tabulated for further analysis. Result: Among 2849 enrolled patients, coronary artery anomalies were identified in 64 (2.24%) patients. Out of which, CAA with abnormal origin and course (Group A), abnormal termination (Group B), and intrinsic coronary arterial anatomy (Group C) were detected in 36 (1.26%), 4 (0.14%), and 24 (0.84%) patients, respectively. Out of 64 cases, a total of 13 (20.3%) patients developed different types of complications, like mechanical (3.125%), embolic (1.56%), and arrhythmic (4.68%), bleeding (3.12%), contrast-induced nephropathy (4.68%), left ventricular failure (3.12%), etc. In group A, complications were more commonly observed in 10 (15.6%) of the cases. Conclusion: CAA with an abnormal origin and course is the most common type of coronary anomaly. Engagement of such an artery and detection of its abnormal course are more commonly associated with life-threatening complications. The use of appropriate manoeuvres, types and size of catheter, and cine views can help to avoid disastrous complications.