Impact of anomalous aortic origin of a coronary artery on coronary angiography: A retrospective analysis

Abstract

Introduction

Anomalous aortic origins of coronary arteries (AAOCA) are not uncommon and are often a challenge for coronary angiography (CA) operators. A detailed evaluation of the effect of AAOCA on CA may help to target the good levers to improve AAOCA catheterisation.

Objective

The objective of this study is to evaluate the impact of AAOCA on the quality of CA catheterisations, as well as the associated costs in terms of time, radiation and contrast injection.

Method

We conducted a retrospective analysis at Félix Guyon University Hospital on Réunion Island, reviewing 23,625 CA cases from May 2011 to December 2022. We identified 96 cases of AAOCA, each matched with a control based on examination type, year, operator, sex, and age. The primary endpoint was the rate of optimal catheterization defined according the position of the distal part of the catheter downstream of the coronary ostium, resting on the coronary artery. Secondary measures included catheterization failure rates, optimal image quality rates, procedural time, radiation exposure, and contrast media use. Qualitative variables were independently evaluated by three experienced operators.

Results

The study found that the optimal catheterization rate for AAOCA patients was significantly lower compared with controls (27.8% vs. 90.6%, p < 0.001). Secondary results highlighted a catheterization failure rate of 7.2% for AAOCA versus 0% for control patients (p < 0.001). The AAOCA cases showed inferior image quality, longer procedural times (31.5 ± 18.2 min vs. 30.9 ± 20.5 min, p < 0.001), increased fluoroscopy time (11.5 ± 7.8 min vs. 6.9 ± 5.0 min, p < 0.001), increased radiation dose (320.5 ± 357.3 vs. 189.9 ± 182.6 mGy·cm², p < 0.001), and higher contrast used (99.6 ± 62.7 ml vs. 61.2 ± 54.4 ml, p < 0.001).

Conclusion

The presence of AAOCA resulted in a significant reduction in the quality of the catheterisation procedure, despite an increase in the cost of time, radiation and contrast. These findings suggest that a standardised protocol may be beneficial in improving the quality of CA catheterisation in cases of AAOCA.