title: Anomalous origin of the coronary artery arising from the opposite sinus: prevalence and outcomes in patients undergoing coronary CTA.
abstract: OBJECTIVE
  The impact of coronary computed tomographic angiography (CTA) on management of anomalous origin of the coronary artery arising from the opposite sinus (ACAOS) remains uncertain. We examined the prevalence, anatomical characterization, and outcomes of ACAOS patients undergoing CTA.
  
  
  RESULTS
  Among 5991 patients referred for CTA at two tertiary hospitals between January 2004 and June 2014, we identified 103 patients (1.7% prevalence) with 110 ACAOS vessels. Mean age was 52 years (range 5-83, 63% male), with 55% previously known ACAOS and 45% discovered on CTA. ACAOS subtypes included: 39% interarterial (n = 40 anomalous right coronary artery, n = 3 anomalous left coronary artery), 38% retroaortic, 15% subpulmonic, 5% prepulmonic, and 2% other. ACAOS patients were assessed for symptoms, ischaemic test results, revascularization, all-cause or cardiovascular (CV) death, and myocardial infarction. CTAs were reviewed for ACAOS course, take-off height and angle, length and severity of proximal narrowing, intramural course, and obstructive coronary artery disease (CAD). In follow-up (median 5.8 years), there were 20 surgical revascularizations and 3 CV deaths. After adjusting for obstructive CAD (n = 21/103, 20%), variables associated with ACAOS revascularization included the following: CV symptoms, proximal vessel narrowing ≥50%, length of narrowing >5.4 mm, and an interarterial course.
  
  
  CONCLUSIONS
  The prevalence of ACAOS on CTA was 1.7%, including 45% of cases discovered incidentally. CTA provided excellent characterization of ACAOS features associated with coronary revascularization, including the length and severity of proximal vessel narrowing.
authors: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA.
authors: Michael K
authors: MK
authors: Cheezum
authors: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Brian
authors: B
authors: Ghoshhajra
authors: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA.|Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil.
authors: Marcio S
authors: MS
authors: Bittencourt
authors: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA.|Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD, USA.
authors: Edward A
authors: EA
authors: Hulten
authors: Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Ami
authors: A
authors: Bhatt
authors: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA.
authors: Negareh
authors: N
authors: Mousavi
authors: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Nishant R
authors: NR
authors: Shah
authors: Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA.|Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
authors: Anne Marie
authors: AM
authors: Valente
authors: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Frank J
authors: FJ
authors: Rybicki
authors: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Michael
authors: M
authors: Steigner
authors: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Jon
authors: J
authors: Hainer
authors: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Thomas
authors: T
authors: MacGillivray
authors: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Udo
authors: U
authors: Hoffmann
authors: Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Suhny
authors: S
authors: Abbara
authors: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA.
authors: Marcelo F
authors: MF
authors: Di Carli
authors: Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Doreen
authors: D
authors: DeFaria Yeh
authors: Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA.|Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
authors: Michael
authors: M
authors: Landzberg
authors: Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Richard
authors: R
authors: Liberthson
authors: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA rblankstein@partners.org.|Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA.
authors: Ron
authors: R
authors: Blankstein
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization / Q000379:methods; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D012850:Sinus of Valsalva / Q000002:abnormalities* / Q000000981:diagnostic imaging; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
keywords: anomalous coronary artery; coronary computed tomographic angiography; prognosis; revascularization; sudden cardiac death