Impact of Anomalous Aortic Origin of Coronary Artery on Coronary Angiography: A Comparative Study

Background Anomalous aortic origin of a coronary artery (AAOCA) presents significant challenges during coronary angiography (CA), impacting procedural success rates. Although existing literature on AAOCA prevalence and risks, no study has quantified its specific impact on CA outcomes. Aims This study aimed to evaluate AAOCA's effect on CA success and safety, focusing on catheterization success rates, procedural quality, radiation exposure, and iodine contrast usage. Methods We conducted a retrospective cohort study including 96 patients with confirmed AAOCA (AAOCA+) matched with 96 controls (AAOCA-), based on single-center data from 2011 to 2022. Key endpoints were selective catheterization success rate, injection quality, fluoroscopy time, radiation exposure, and the amount of contrast. Statistical analyses were performed using conditional logistic regressions and generalized estimating equations. Results Selective catheterization was significantly less successful in the AAOCA+ group compared to the AAOCA- group (28.1% vs. 90.6%; OR: 24.1, 95% CI: 10.3-62.6, p < 0.0001). The AAOCA+ group also demonstrated lower injection quality (61.5% vs. 100%, p < 0.0001), longer fluoroscopy times (11.4 +/- 0.8 vs. 5.9 +/- 0.8 min, p < 0.0001), higher radiation exposure (310.8 +/- 35.8 vs. 189.9 +/- 36.4 mGy, p = 0.02), and greater iodine contrast usage (99.5 +/- 6.7 vs. 61.2 +/- 7.6 mL, p = 0.0001). Conclusions AAOCA significantly impacts the diagnostic catheterization success rate and increases the risk factors associated with CA. These findings highlight the need for specialized training and optimized protocols to improve outcomes.