Coronary artery disease in adults with anomalous aortic origin of a coronary arteryCentral MessagePerspective
Michael X. Jiang, MD, MEng,
Ellen K. Brinza, MS,
Joanna Ghobrial, MD,
Dominique L. Tucker, BS,
Sohini Gupta, BA,
Jeevanantham Rajeswaran, PhD,
Tara Karamlou, MD, MSc,
Eugene H. Blackstone, MD,
Elizabeth V. Saarel, MD,
Sohini Gupta, BA,
Miza Salim Hammoud, MD,
Kiran A. Vaidya, BS,
Michael J. Haupt, BS,
Joshua W. Cockrum, BS,
Christiane Mhanna, DO,
Joanna Ghobrial, MD,
Munir Ahmad, MD,
Paul Schoenhagen, MD,
Gösta B. Pettersson, MD, PhD,
Hani K. Najm, MD, MSc,
Robert D. Stewart, MD, MPH
Affiliations
Michael X. Jiang, MD, MEng
Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, Ohio
Ellen K. Brinza, MS
Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
Joanna Ghobrial, MD
Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Dominique L. Tucker, BS
Case Western Reserve University School of Medicine, Cleveland Clinic, Cleveland, Ohio
Sohini Gupta, BA
Case Western Reserve University School of Medicine, Cleveland Clinic, Cleveland, Ohio
Jeevanantham Rajeswaran, PhD
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
Tara Karamlou, MD, MSc
Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Address for reprints: Tara Karamlou, MD, MSc, Division of Pediatric Cardiac Surgery and the Heart Vascular, and Thoracic Institute, 9500 Euclid Ave, M41-022A, Cleveland, OH 44195.
Eugene H. Blackstone, MD
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Elizabeth V. Saarel, MD
Department of Pediatric Cardiology, Cleveland Clinic, Cleveland, Ohio; Department of Pediatric Cardiology, St. Luke's Children's Hospital, Boise, Idaho
Sohini Gupta, BA
Case Western Reserve University School of Medicine, Cleveland, Ohio
Miza Salim Hammoud, MD
Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Kiran A. Vaidya, BS
Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
Michael J. Haupt, BS
Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
Joshua W. Cockrum, BS
Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
Christiane Mhanna, DO
Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, Ohio
Joanna Ghobrial, MD
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
Munir Ahmad, MD
Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Paul Schoenhagen, MD
Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, Ohio
Gösta B. Pettersson, MD, PhD
Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Hani K. Najm, MD, MSc
Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Robert D. Stewart, MD, MPH
Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Surgery, Akron Children's Hospital, Akron, Ohio
Objectives: This study sought to characterize coronary artery disease (CAD) among adults diagnosed with an anomalous aortic origin of a coronary artery (AAOCA). We hypothesized that coronaries with anomalous origins have more severe CAD stenosis than coronaries with normal origins. Methods: This single-center study of 763 adults with AAOCA consisted of 620 patients from our cardiac catheterization database (1958-2009) and 273 patients from electronic medical records query (2010-2021). Within left main, anterior descending, circumflex, and right coronary arteries, the CAD stenosis severity, assessed by invasive or computer tomography angiography, was modeled with coronary-level variables (presence of an anomalous origin) and patient-level variables (age, sex, comorbidities, and which of the four coronaries was anomalous). Results: Of the 763 patients, 472 (60%) had obstructive CAD, of whom, 142/472 (30%) had obstructive CAD only in the anomalous coronary. Multivariable modeling showed similar CAD stenosis severity between coronaries with anomalous versus normal origins (P = .8). Compared with AAOCA of other coronaries, the anomalous circumflex was diagnosed at older ages (59.7 ± 11.1 vs 54.3 ± 15.8 years, P < .0001) and was associated with increased stenosis in all coronaries (odds ratio, 2.7; 95% confidence interval, 2.2-3.4, P < .0001). Conclusions: Among adults diagnosed with AAOCA, the anomalous origin did not appear to increase the severity of CAD within the anomalous coronary. In contrast to the circumflex, AAOCA of the other vessels may contribute a greater ischemic burden when they present symptomatically at younger ages with less CAD. Future research should investigate the interaction between AAOCA, CAD, and ischemic risk to guide interventions.
