The prevalence and characteristics of intra-atrial right coronary artery anomaly in 9,284 patients referred for coronary computed tomography angiography

• Published in: European journal of radiology Vol. 83; no. 7; pp. 1129 - 1134
• Main Authors: Opolski, Maksymilian P., Pregowski, Jerzy, Kruk, Mariusz, Staruch, Adam D., Witkowski, Adam, Demkow, Marcin, Hryniewiecki, Tomasz, Michalek, Piotr, Ruzyllo, Witold, Kepka, Cezary
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.07.2014
• Subjects: Age Distribution; Causality; Comorbidity; Congenital; Coronary Angiography - statistics & numerical data; Coronary artery anomaly; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Coronary computed tomography angiography; Coronary Vessel Anomalies - diagnostic imaging; Coronary Vessel Anomalies - epidemiology; Female; Heart Atria - abnormalities; Heart Atria - diagnostic imaging; Humans; Male; Middle Aged; Poland; Prevalence; Prognosis; Radiology; Referral and Consultation - statistics & numerical data; Reproducibility of Results; Right atrium; Risk Factors; Sensitivity and Specificity; Sex Distribution; Tomography, X-Ray Computed - statistics & numerical data; Congenital; Right atrium; Coronary computed tomography angiography; Coronary artery anomaly
• ISSN: 0720-048X; 1872-7727; 1872-7727
• DOI: 10.1016/j.ejrad.2014.04.017

To determine the prevalence, radiologic patterns and clinical characteristics of intra-atrial right coronary artery (IARCA) among adult coronary computed tomography angiography (CCTA) population. 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. The IARCA prevalence was 0.15% (14/9,284) with 15 intra-atrial segments. The intra-atrial segment length ranged from 14 to 53mm, and the mean diameter proximal to the entry site was 3.3±0.7mm. 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. 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.