0115: Coronary Artery Anomalies and Culprit Lesions in Patients with Acute Myocardial Infarction: a Large Population-Based Study

Coronary Artery Anomalies (CAA), including anomalies of coronary origin (ANOCOR) and ectasia or coronary aneurysms (ECTACOR) share common entities. In coronary angiographies or autopsy series, their prevalence range from 0.2 to 1.5%. Case control studies reported an association between CAA and acute myocardial infarction (MI). We aimed to analyze their prevalence, characteristics, therapeutic strategies and prognosis in patients with acute MI. All the consecutive patients admitted in the intensive care unit of our hospital who underwent coronary angiography for an acute MI from 2001 to 2013 were retrospectively analysed. Among the 9393 patients included during the study period, 80(0.92%) CAA were identified, including 37 (46%), ANOCOR and 43 (54%) ECTACOR. Most were male (86%), with a mean age at 61±14 y, and 2.1±1.4 risk factors. The most frequent localisation of ANOCOR was the circumflex artery (65%). The abnormal artery corresponds to the culprit lesion in 30% of cases, and 46% had significant stenosis. In contrast, ECTACOR were mainly localised on the right coronary artery (58%), and correspond to the culprit lesion in 70% of the cases, and 60% had a significant stenosis. A minority, i.e. 41% of the significant lesions found on ANOCOR and 31% of those on ECTACOR, received only a medical treatment, while 47% and 58% were stented, or 12% and 12% underwent Coronary Artery Bypass Surgery, respectively. After Percutaneous Coronary Intervention (PCI), final flow was TIMI 3 in most cases (94% and 81%, respectively). Only one patient died during the hospital stay. In our large retrospective study, the prevalence of CAAs is consistent with older angiographic series. Culprit lesion was more frequently associated with ECTACOR, but not with ANOCOR. The majority of significant lesions was treated by coronary stenting with a successful angiographic result.