title: The distribution and prognosis of anomalous coronary arteries identified by cardiovascular magnetic resonance: 15 year experience from two tertiary centres.
abstract: BACKGROUND
  Aberrant coronary arteries represent a diverse group of congenital disorders. Post-mortem studies reveal a high risk of exercise-related sudden cardiac death in those with an anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS) with an inter-arterial course. There is little documentation of lifetime history and long-term follow-up of patients with coronary artery anomalies.
  
  
  METHODS
  Patients with anomalous coronary arteries undergoing cardiovascular magnetic resonance over a 15-year period were identified and classified by anatomy and course. Medical records were reviewed for major adverse cardiovascular events (MACE). Revascularisation or myocardial infarction counted only if occurring in the distribution of the anomalous artery.
  
  
  RESULTS
  Consecutive patients with coronary artery anomalies were retrospectively identified (n = 172). Median follow-up time was 4.3 years (IQR 2.5-7.8, maximum 15.6). 116 patients had ACAOS of which 64 (55%) had an inter-arterial course (IAC) and 52 (45%) did not. During follow up 110 ACAOS patients were alive, 5 died and 1 lost to follow-up.ACAOS patients experienced 58 MACE events (5 cardiovascular deaths, 5 PCI, 24 CABG and 24 had myocardial infarction). 47 MACE events occurred in ACAOS with IAC and 11 in those without (p < 0.0001), the statistical difference driven by surgical revascularisation and myocardial infarction.
  
  
  CONCLUSIONS
  In life, patients with an anomalous coronary artery originating from the opposite sinus of Valsalva taking an IAC have higher rates of both myocardial infarction and surgical revascularisation during long-term follow up, compared to those without IAC.
authors.forename: David P
authors.initials: DP
authors.lastname: Ripley
authors.forename: Ansuman
authors.initials: A
authors.lastname: Saha
authors.forename: Albert
authors.initials: A
authors.lastname: Teis
authors.forename: Akhlaque
authors.initials: A
authors.lastname: Uddin
authors.forename: Petra
authors.initials: P
authors.lastname: Bijsterveld
authors.forename: Ananth
authors.initials: A
authors.lastname: Kidambi
authors.forename: Adam K
authors.initials: AK
authors.lastname: McDiarmid
authors.forename: Mohan
authors.initials: M
authors.lastname: Sivananthan
authors.forename: Sven
authors.initials: S
authors.lastname: Plein
authors.forename: Dudley J
authors.initials: DJ
authors.lastname: Pennell
authors.affiliation: Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK. j.greenwood@leeds.ac.uk.
authors.forename: John P
authors.initials: JP
authors.lastname: Greenwood
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D001026:Coronary Artery Bypass; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology*; D004739:England; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012850:Sinus of Valsalva / Q000002:abnormalities*; D062606:Tertiary Care Centers; D013997:Time Factors; D055815:Young Adult