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