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Anomalous origin of culprit coronary arteries in acute coronary syndromes


- Institute of Cardiology, Department of Interventional Cardiology and Angiology, Alpejska 42 Street, 04-628 Warsaw, Poland
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland, Poland
- First Department of Cardiology, Medical University of Silesia, Ziołowa 47 Street, 40-635 Katowice, Poland
- Institute of Cardiology, Department of Intensive Cardiac Therapy, Alpejska 42 Street, 04-628 Warsaw, Poland
open access
Abstract
Background: The aim of the study was to describe a series of acute coronary syndrome (ACS) patients in whom anomalous origin of culprit coronary artery (AOCCA) was diagnosed. Percutaneous coronary interventions (PCI) in AOCCA are performed very infrequently.
Methods: Electronic databases from three high-volume tertiary cardiac centers were retrospectively searched for the presence of AOCCA in ACS.
Results: Different types of AOCCA in ACS were identified in 20 patients. The most frequent AOCCA was left circumflex coronary artery (LCx) originating from right coronary artery (RCA) or directly from the right coronary sinus (RCS), n = 13, followed by high/atypical RCA, n = 3, left coronary artery (LCA) originating from RCS (n = 3) with either RCA-AOCCA (n = 1) or left anterior descending coronary artery (LAD)-AOCCA (n = 1) or RCA originating from left sinus of Valsalva, (n = 1), LAD originating from RCA (n = 1). In 1 ST-segment elevation myocardial infarction (STEMI)-patient RCA-AOCCA cannulation was unsuccessful, in 1 non-STEMI-patient AOCCA was missed, 1 ACS- -patient was treated surgically and 1 ACS-patient was treated conservatively (both patients with non- STEMI). In the remaining patients PCI was successfully performed.
Conclusions: The most frequently encountered AOCCA is LCx branching-off from RCA. AOCCA may either be difficult to cannulate and PCI aborted even in STEMI, or missed, especially when the intermediate branch from LCA is mimicking proper LCx.
Abstract
Background: The aim of the study was to describe a series of acute coronary syndrome (ACS) patients in whom anomalous origin of culprit coronary artery (AOCCA) was diagnosed. Percutaneous coronary interventions (PCI) in AOCCA are performed very infrequently.
Methods: Electronic databases from three high-volume tertiary cardiac centers were retrospectively searched for the presence of AOCCA in ACS.
Results: Different types of AOCCA in ACS were identified in 20 patients. The most frequent AOCCA was left circumflex coronary artery (LCx) originating from right coronary artery (RCA) or directly from the right coronary sinus (RCS), n = 13, followed by high/atypical RCA, n = 3, left coronary artery (LCA) originating from RCS (n = 3) with either RCA-AOCCA (n = 1) or left anterior descending coronary artery (LAD)-AOCCA (n = 1) or RCA originating from left sinus of Valsalva, (n = 1), LAD originating from RCA (n = 1). In 1 ST-segment elevation myocardial infarction (STEMI)-patient RCA-AOCCA cannulation was unsuccessful, in 1 non-STEMI-patient AOCCA was missed, 1 ACS- -patient was treated surgically and 1 ACS-patient was treated conservatively (both patients with non- STEMI). In the remaining patients PCI was successfully performed.
Conclusions: The most frequently encountered AOCCA is LCx branching-off from RCA. AOCCA may either be difficult to cannulate and PCI aborted even in STEMI, or missed, especially when the intermediate branch from LCA is mimicking proper LCx.
Keywords
anomalous origin culprit coronary artery, percutaneous coronary intervention, acute coronary syndrome


Title
Anomalous origin of culprit coronary arteries in acute coronary syndromes
Journal
Issue
Pages
683-690
Published online
2017-12-01
Page views
3296
Article views/downloads
1379
DOI
Pubmed
Bibliographic record
Cardiol J 2018;25(6):683-690.
Keywords
anomalous origin culprit coronary artery
percutaneous coronary intervention
acute coronary syndrome
Authors
Paweł Tyczyński
Krzysztof Kukuła
Arkadiusz Pietrasik
Tomasz Bochenek
Artur Dębski
Anna Oleksiak
Miłosz Marona
Michał Lelek
Janina Stępińska
Adam Witkowski


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