title: Intramural coronary arterial course is associated with coronary arterial stenosis and prognosis of major cardiac events.
abstract: OBJECTIVE
  The clinical significance of an intramural course (or bridging) of the coronary artery remains controversial. We investigated the relationship between intramural coronary arteries (ICAs) and coronary stenosis and prognosis of subjects with ICA.
  
  
  RESULTS
  ICA and coronary stenosis were assessed by multidetector computed tomography coronary angiography. ICAs in the left anterior descending artery were studied, which were further classified as superficial (≤2 mm) or deep type (>2 mm). Coronary stenosis was classified as nonstenosis, insignificant stenosis (<50%), and significant stenosis (≥50%). A total of 261 subjects with ICA in left anterior descending artery were identified from 2318 enrolled subjects. Most of the ICAs (66.3%) were superficial. ICA was positively associated with insignificant stenosis, and the odds ratios were 2.055 (95% confidence interval, 1.405-3.007), 3.314 (1.818-6.039), and 1.640 (1.036-2.597) for overall, deep, and superficial ICA (all P<0.05), respectively. In the case of significant stenosis, ICA was negatively associated, and the odds ratios were 0.555 (0.416-0.739) and 0.413 (0.288-0.590) for overall and superficial ICA (both P<0.05), respectively, and 0.985 (0.611-1.588; P>0.05) for deep ICA type. The depth and location of ICA correlated with stenosis. The major cardiac events, including cardiovascular death, myocardial infarction, and revascularization, were recorded during 3-year follow-up. ICA predicted a lower incidence of major cardiac events, especially superficial type; the adjusted hazard ratios were 0.585 (0.375-0.911; P=0.018) and 0.535 (0.300-0.954; P=0.034) for total and superficial type, respectively.
  
  
  CONCLUSIONS
  ICA, especially deep type, is positively associated with insignificant stenosis proximal to ICA. Meanwhile, ICA, especially superficial type, is negatively associated with significant stenosis proximal to ICA and predicts a better prognosis not only in normal subjects but also in patients with coronary artery disease.
authors.affiliation: Fuwai Hospital, Chinese Academy of Medical Sciences, 167 Beilishi Rd, Beijing 100037, China.
authors.forename: Yibo
authors.initials: Y
authors.lastname: Wang
authors.forename: Bin
authors.initials: B
authors.lastname: Lv
authors.forename: Jinxing
authors.initials: J
authors.lastname: Chen
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: Fang
authors.initials: F
authors.lastname: Luo
authors.forename: Na
authors.initials: N
authors.lastname: Lu
authors.forename: Kai
authors.initials: K
authors.lastname: Sun
authors.forename: Zhihui
authors.initials: Z
authors.lastname: Hou
authors.forename: Huili
authors.initials: H
authors.lastname: Cao
authors.forename: Irfan
authors.initials: I
authors.lastname: Zeb
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.forename: Rutai
authors.initials: R
authors.lastname: Hui
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors