Prevalence and characteristics of coronary artery anomalies in 12401 adult patients: a coronary angiographic study from Northern Greece

Purpose: Since regional and ethnic variations of the incidence of CAA have been reported, our aim was to estimate their incidence in a population from Northern Greece, which has not been previously studied. Methods: A series of 12401 coronary angiograms, performed between January 2003 and December 2011 in a cardiac catheterization unit at our institution was retrospectively reviewed for the presence of coronary artery anomalies. Results: The overall incidence of isolated coronary artery anomalies was 1.35% (167/12401, mean age: 62.9±11.6 years, males: 74.3%). The most common coronary anomaly was separate ostia for Left Anterior Descending artery (LAD) and circumflex artery (Cx) inside the left sinus of Valsava (SoV), with an incidence of 0.48% (59/12401) or 35.3% of all coronary anomalies. The second most common anomaly was origin of Cx from the right side with an incidence of 0.35% (43/12401) or 25.7% of all coronary anomalies. Regarding the anomalous origin of the Cx from the right SoV, three distinct anatomical variants of the ostium of the anomalous left circumflex coronary artery were identified: a) separate ostia for Right Coronary Artery (RCA) and anomalous circumflex within the right sinus of Valsalva (type I, n=20, 46.5%), b) common ostia in the right sinus (type II, n=13, 30.2%), and c) Cx arising arising as a branch of the proximal RCA (type III, n=10, 23.3%). In all cases the anomalous Cx had a posterior course to the aorta. Anomalous RCA origin was found in 41 cases (0.33% or 24.6% of all coronary anomalies). It originated separately from the left sinus of Valsalva (SV) in eighteen patients (an incidence 0.14% or 10.8% of all anomalies). A single coronary artery arising from the right SoV was seen in four patients (0.03% or 2.4% of anomalies). An absent circumflex or super-dominant RCA in 2 cases (0.02% or 1.2% of anomalies). In this series we also found also seventeen cases of coronary fistulas (0.13% or 10.2% of anomalies). In one patient coronary angiography revealed congentital left main coronary artery atresia (0.008%) with a dominant RCA providing intercoronary retrograde collateral to the left anterior descending artery (LAD) and left circumflex artery (LCx). Conclisions: The incidence of coronary artery anomalies in our study population was 1.35%. The most common type was separate ostia for LAD and Cx inside the left SoV and second most common the origin of the Cx from the right sinus of Valsalva. Although geographic variations in the incidence of CAA have been reported, these results are in agreement with previously published large angiographic series.