Abstract 18681: Association Between Type of Coronary Artery Anomaly, Cardiac Surgery, and Death in Adults
Introduction: Anomalies of coronary artery origin where the artery arises from the opposite aortic cusp are associated with adverse cardiac events; those of the left main and the left anterior descending coronary arteries (LMCA and LAD) are thought to be at particular risk. However, there are few outcomes data on anomalies identified in adulthood; existing outcomes data are derived from the pediatric population. We determined the relationship between anomaly type, cardiac surgery, and death in adults.
Methods: 73 individuals ≥19 years of age with anomalies of coronary artery origin were identified from the institutional imaging and catheterization databases. Anomaly type and whether surgery was performed were ascertained by chart review. Anomalies were grouped into 3 categories: 1) left circumflex coronary artery arising from right cusp (n=26); 2) right coronary artery (RCA) arising from left cusp (n=32); and 3) all other anomalies (n=15). Vital status was ascertained from the Social Security Death Index. Association between type of anomaly and mortality was investigated by Cox proportional hazards models, adjusting for surgical management and age at diagnosis.
Results: Mean age at diagnosis was 56±14 years (55% male, 59% white). As of November 5, 2012, 27 had died. The relationship between anomaly type, surgical management, and mortality is in the table. After adjustment, RCA anomaly (hazard ratio [HR] 3.5, 95% confidence interval [CI] 1.2, 9.9) was associated with increased mortality; undergoing surgery (HR 0.07, 95% CI 0.01, 0.56) was associated with decreased mortality.
Conclusion: This represents the largest outcomes study of adults with anomalous coronary artery origin. In this group, anomalous RCA is associated with higher incidence of overall mortality than other types of anomalies, including those of LMCA and LAD. This finding is surprising, since the prevailing view suggests that RCA anomaly carries less risk than those of the LMCA or LAD.
- © 2013 by American Heart Association, Inc.