Anomalous origin of the coronary artery coursing between the great vessels presenting with a cardiovascular event (J-CONOMALY Registry)

Koichi Nagashima, Takafumi Hiro, Daisuke Fukamachi, Yasuo Okumura, Ichiro Watanabe, Atsushi Hirayama, Masashi Tanaka, Tomofumi Tanaka, Itaru Takamisawa, Isao Taguchi, Akira Sato, Kazutaka Aonuma, Seiji Fukamizu, Akihiro Nakada, Atsuyuki Watanabe, Naofumi Amioka, Yasuyuki Suzuki, Naoya Matsumoto, Junichi Koizumi, Kazuya KumagaiMasanao Naya, Yoshiharu Higuchi, Yoshiro Naito, Tohru Masuyama, Mitsuharu Kawamura, Ryusuke Tsunoda, Susumu Suzuki, Hideki Ishii, Toyoaki Murohara, Takeshi Shimizu, Yasuchika Takeishi, Kazuki Shiina, Jun Yamashita, Tomohiko Imamura, Naokata Sumitomo, Teruo Noguchi, Toshihide Aso, Kojiro Furukawa, Yasuteru Yamauchi, Kaoru Okishige, Kenji Sakata, Masakazu Yamagishi, Shigeo Shimizu, Masakazu Ohno, Teruyasu Sugano, Koichiro Matsumura, Kensuke Matsumoto, Kazuyuki Ozaki, Shunji Hayashidani, Hiroshi Meno, Atsushi Iwata, Takumi Higuma, Hirofumi Tomita, Hideaki Yoshino, Seiichi Taniai, Koki Shishido, Masato Murakami, Koji Negishi, Masaki Nii, Daisuke Wakatsuki, Hiroshi Suzuki, Yuji Motoike, Yukio Ozaki, Jun Nakazato, Hidemori Hayashi, Satoshi Higuchi, Morio Shoda

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Aims: Anomalous origin of the coronary artery (AOCA) with an inter-arterial course (IAC) between the great vessels poses a risk for a life-threatening cardiovascular event. We assessed, in a registry-based study, the clinical features, treatment strategies, and prognoses of life-threatening cardiovascular events ensuant to AOCA. Methods and results: Included were 65 AOCA patients (48 men/17 women, aged 41 ± 23 years) from 40 clinical centres who had experienced sudden cardiac arrest (SCA) (n = 30), acute myocardial infarction (AMI) (n = 5), angina (n = 23), or syncope (n = 7). The anomalous vessel was the right coronary artery in 72% of patients and left coronary artery in 28%; the ostium was slit-like in 42%. Coronary luminal narrowing ≥75% was absent in patients with SCA or syncope (86% and 57%, respectively), but occlusion or narrowing was seen in those with AMI (100%) or angina (52%). Age ≤40 years, male sex, sporting activity, absence of prodromal symptoms, acutely angled (≤30°) take-off from the aorta, and absence of luminal narrowing of the IAC segment were associated with SCA in this patient group. Coronary vasospasm was inducible in 12 of 17 patients without coronary narrowing. Management included surgical revascularization (n = 26) percutaneous coronary intervention (n = 9), and medical treatment (n = 26). Four SCA patients died while hospitalized; no others died during the median 5.0 (range, 1.8-7.0)-year follow-up period. Conclusions: In patients with AOCA, age ≤40 years, male sex, sporting activity, and an acute take-off angle appear to be risk factors for SCA. Appropriate management can be beneficial. Confirmation in a large-scale study is warranted.

元の言語英語
ページ(範囲)222-230
ページ数9
ジャーナルEuropean heart journal cardiovascular Imaging
21
発行部数2
DOI
出版物ステータス出版済み - 2 1 2020

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Nagashima, K., Hiro, T., Fukamachi, D., Okumura, Y., Watanabe, I., Hirayama, A., Tanaka, M., Tanaka, T., Takamisawa, I., Taguchi, I., Sato, A., Aonuma, K., Fukamizu, S., Nakada, A., Watanabe, A., Amioka, N., Suzuki, Y., Matsumoto, N., Koizumi, J., ... Shoda, M. (2020). Anomalous origin of the coronary artery coursing between the great vessels presenting with a cardiovascular event (J-CONOMALY Registry). European heart journal cardiovascular Imaging, 21(2), 222-230. https://doi.org/10.1093/ehjci/jez076