Anomalous Coronary Arteries: Analysis of Clinical Outcome Based Upon Arterial Course and Surgical Intervention in an Adult Population

Rationale and Objectives: The study aimed to evaluate the association of a coronary interarterial course (IAC) with adverse outcomes in adults and to assess the benefit of coronary artery bypass grafting (CABG) in this population. Materials and Methods: A retrospective review identified 172 adults over 40 years of age with an anomalous coronary artery origin from the opposite coronary sinus, including 79 patients with an IAC. Hard outcomes (myocardial infarction or cardiac death) and soft outcomes (persistent angina) were evaluated, with a mean follow-up time of 5 years. Results: Although the frequency of coronary artery disease (CAD) was lower among patients with an IAC (43% vs 59%; P < 0.05), the frequency of CABG was higher among those with an IAC (21/79 = 26% vs 16/93 =17%; P = 0.15). Hard outcomes were equally frequent among IAC patients (12/79 = 15%) compared to those without an IAC (16/93 = 17%) (P = 0.7), and among patients with a right IAC (11/68 = 16%) compared to those with a left IAC (1/11 = 9%) (P = 0.56). Among patients with an IAC, the frequency of hard outcomes was similar with CABG (4/21 = 19%) versus without CABG (8/59 = 14%) (P = 0.55); the frequency of soft events was also similar with CABG (9/21 = 43%) versus without CABG (18/59 = 31 %) (P = 0.3). On multivariate analysis, the extent of coronary disease was the only significant predictor of hard or soft outcome (the presence of IAC, CABG, and left vs right IAC were not significant; P>0.3). Conclusions: The frequency of hard and soft outcomes among adult patients with anomalous coronary arteries is not significantly related to the presence of an IAC. No benefit was documented from the CABG treatment of an IAC in the absence of CAD.