The prevalence and characteristics of intra-atrial right coronary artery anomaly in 9,284 patients referred for coronary computed tomography angiography.
OBJECTIVE
To determine the prevalence, radiologic patterns and clinical characteristics of intra-atrial right coronary artery (IARCA) among adult coronary computed tomography angiography (CCTA) population.


METHODS
We included 9,284 consecutive subjects who underwent CCTA at a single high-volume center. The presence of IARCA including the number, length and diameter of IARCA segments with accompanying atherosclerosis and coronary anomalies were evaluated. Additionally, clinical characteristics and midterm follow-up of IARCA patients were recorded.


RESULTS
The IARCA prevalence was 0.15% (14/9,284) with 15 intra-atrial segments. The intra-atrial segment length ranged from 14 to 53 mm, and the mean diameter proximal to the entry site was 3.3 ± 0.7 mm. IARCA was more often associated with intramuscular course of the left anterior descending coronary artery (29% vs. 4%, p=0.001) and anomalous origin of the left circumflex artery from the right aortic sinus (14% vs. 0.3%, p=0.001) compared with non-IARCA cases. The majority of IARCA patients were women (86%) presenting with supraventricular arrhythmia (71%). Compared with computed tomographic population without IARCA, IARCA subjects were younger (60 ± 12 vs. 54 ± 14 years, p=0.037) and more often women (51% vs. 86%, p=0.013). At a mean of 20 months follow-up of IARCA patients there were no adverse cardiac events except for supraventricular tachycardia episodes occurring in 36% of subjects.


CONCLUSIONS
IARCA occurs rarely and is often associated with additional coronary anomalies. The clinical profile of IARCA patients is most often represented by middle-aged women with supraventricular arrhythmia showing favorable midterm prognosis.
Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. Electronic address: opolski.mp@gmail.com.
Maksymilian P
MP
Opolski
Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. Electronic address: jerzypregowski74@gmail.com.
Jerzy
J
Pregowski
Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland. Electronic address: mariuszkruk2000@yahoo.com.
Mariusz
M
Kruk
Medical University of Warsaw, Warsaw, Poland. Electronic address: adstarman@gmail.com.
Adam D
AD
Staruch
Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. Electronic address: witkowski@hbz.pl.
Adam
A
Witkowski
Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland. Electronic address: mdemkow@ikard.pl.
Marcin
M
Demkow
Department of Acquired Cardiac Defects, Institute of Cardiology, Warsaw, Poland. Electronic address: t.hryniewiecki@ikard.pl.
Tomasz
T
Hryniewiecki
Department of Immediate Diagnostics, Institute of Cardiology, Warsaw, Poland. Electronic address: p.michalek@ikard.pl.
Piotr
P
Michalek
Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland. Electronic address: w.ruzyllo@ikard.pl.
Witold
W
Ruzyllo
Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland. Electronic address: c.kepka@ikard.pl.
Cezary
C
Kepka
D017677:Age Distribution; D015984:Causality; D015897:Comorbidity; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006325:Heart Atria / Q000002:abnormalities / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland; D015995:Prevalence; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
Congenital; Coronary artery anomaly; Coronary computed tomography angiography; Right atrium