Coronary arteries anomalies in patients with acute coronary syndrome: report from a second level hospital
Authors: Sanz Ortega I , Bravo Martinez I , Velasco Del Castillo S , Sadaba Sagredo M , Zugazabeitia Irazabal G , Romero Pereriro A , Rumoroso Cuevas JR , Salcedo Arruti A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Coronary arteries anomalies are rare, affecting around 1% of the general population (routine autopsy), ranging from 0.3%-5.6% in studies on patients undergoing coronary angiography. They can be anomalies of origination and course, of intrinsic anatomy and of termination, alone or associated to other congenital anomalies. Cases of acute coronary syndromes (ACS) (ST-elevation myocardial infarction (STEMI), non- ST-elevation myocardial infarction (non-STEMI) or unstable angina (UA)) can happen in the anomalous vessels, some of them treated by percutaneous coronary intervention (PCI), as reported.

Purpose
To describe cases of coronary arterial anomalies in patients with acute coronary syndrome at our hospital.

Methods
We selected cases of patients with ACS and coronary anomalies in angiography. Coronary anomaly, culprit lesion description, characteristics of patients and vessels were reported.

Results
There were 6 ACS in 5 patients (Cases 5 and 6 correspond to the same patient). All were men except 1 case. Mean actual age was 72.7 years old (range: 58 to 82). Mean age at the event was 67.2 years old (range: 55 to 79). All cases had 2 cardiovascular risk factors. They were diabetes mellitus, hypertension, smoke and ex-smoke, dyslipidemia. 2 cases were STEMI (33%), 3 non-STEMI (50%) and 1 UA (17%). In 3 cases (50%), culprit lesion was in the anomalous vessel (1 case in a previously stented vessel), all circumflex artery. The other cases happened in non-anomalous vessels: left anterior descendent, diagonal branch and 2nd obtuse marginal artery. Female patient had STEMI due to spontaneous coronary artery dissection (17% cases) in 2nd obtuse marginal artery (no anomalous vessel) at 55 years old, treated conservatively (now 71 years old). Atherosclerosis was the responsible for the rest of cases: all men, with actual mean age 73 (range: 58 to 82) and mean age at event 69.6 (range 57 to 79). Among atherosclerotic cases, 4 were treated with PCI (80%) and in 1 PCI was failed (the case in which anomalous artery was stented before due to a previous ACS). Among lesions treated by PCI, 2 were in an anomalous circumflex. Detected coronary anomalies were: 2 single coronary with right coronary agenesis and circumflex continues and gives acute marginal branches, 1 circumflex arising from right coronary, little fistula from septal branch to pulmonary artery, 2 circumflex arising from right coronary sinus independent from right coronary (both in the same patient). Characteristics of patients are summarized in table 1. Some figures from angiographies are shown in picture 1.

Conclusions
Although rare, any type of coronary anomalies can be seen in ACS patients, in anomalous and non-anomalous vessels, mostly atherosclerotic, but also spontaneous coronary dissections. In our series, cases are mainly non-STEMI cases and when the culprit lesion affects the anomalous vessel, circumflex artery is the responsible.