Journal of Clinical and Diagnostic Research. 2023 Jul, Vol-17(7): OC45-OC48 45 45 DOI: 10.7860/JCDR/2023/61469.18246 Original Article Internal Medicine Section Prevalence of Coronary Artery Anomalies and Associated Complications during Catheter-guided Angiography: A Retrospective Study SIBARAM PANDA 1 , SUNIL KUMAR SHARMA 2 , MAYADHAR PANDA 3 ABSTRACT Introduction: Coronary Artery Anomalies (CAA) refer to very uncommon and unusual morphological features of the epicardial coronary artery that account for 1/5 th of deaths in athletes. Patients with CAA are also prone to developing significant Coronary Artery Disease (CAD). Identifying such arteries during catheter-guided angiography is very challenging and is associated with many devastating complications, such as arrhythmia, heart failure, Contrast-Induced Nephropathy (CIN), bleeding, cardio-embolic events, and mechanical injury to the coronary artery, among others. Aim: The aim of this study is to describe the prevalence of various types of coronary anomalies and the complications that arise during catheter-guided angiography. Materials and Methods: A retrospective study was conducted between February 2022 and October 2022, enrolling a total of 2849 patients who underwent angiography for angina or angina equivalents at the catheterisation laboratory, VIMSAR, Burla, Odisha, India. Angiographic records and videos of patients were noted. Coronary anomalies were detected based on quantitative and qualitative criteria provided by the American Heart Association in 2007. The anomalous coronary arteries were classified into three groups: Group A- anomalies of origin and course, Group B- anomalies of intrinsic coronary arterial anatomy, and Group C- anomalies of coronary termination. Data regarding baseline characteristics and procedure- related complications were collected, compiled, and tabulated to determine the prevalence of different types of coronary anomalies and the arising complications during catheter- guided angiography. Results: Among the 2849 enrolled patients, CAA was identified in 64 (2.24%) patients. Of these, CAA with abnormal origin and course (Group A), abnormal termination (Group B), and intrinsic coronary arterial anatomy (Group C) were detected in 36 (1.26%), 4 (0.14%), and 24 (0.84%) patients, respectively. Out of the 64 cases, a total of 13 (20.3%) patients developed different types of complications, including mechanical 2 (3.125%), embolic 1 (1.56%), and arrhythmic 3 (4.68%) complications, bleeding 2 (3.12%), angiographic 3 (4.68%), and left ventricular failure 2 (3.12%), among others. In Group A, complications were more commonly observed in 10 (15.6%) of the cases. Conclusion: CAA with an abnormal origin and course is the most common type of coronary anomaly. Engaging such an artery and detecting its abnormal course are more commonly associated with life-threatening complications. The use of appropriate maneuvers, types and sizes of catheters, and CIN views can help avoid disastrous complications. INTRODUCTION The CAA refers to a very uncommon (<1% in the unselected general population) and unusual morphological features (intrinsic anatomy, origin, course, or termination) of the epicardial coronary artery [1,2]. Patients with CAA are prone to develop CAD and sudden cardiac death due to their unusual morphological features [3]. Catheter-directed angiography is the gold standard procedure for the diagnosis of CAD [4]. Devastating complications (arrhythmic, mechanical, iatrogenic, cardio-embolic, bleeding, etc.) arise more frequently due to delayed identification and difficult engagement during angiographic procedures [4,5]. Although studies regarding the prevalence of coronary anomalies are prevalent, studies regarding the prevalence with respect to their morphologic subtypes are very limited [6-11]. More surprisingly, to date, no study has been conducted regarding the prevalence of complications arising during angiography in cases of coronary anomalies with regard to their morphological subtypes, creating a significant knowledge gap in this regard. Therefore, the present study was planned to determine the prevalence of different types of CAA and their procedure-related complications to derive a solution to reduce the risk to patients. MATERIALS AND METHODS A retrospective study was conducted in the catheterisation laboratory, Department of Cardiology, VIMSAR, Burla, Odisha, India, between February 2022 and October 2022, after obtaining the approval of the Institutional Ethics Committee (IEC number-153/I-F-O/21). Inclusion and Exclusion criteria: Patients who underwent coronary angiography (for angina or angina equivalents) over a period of the last 11 years, between 2011 and 2022, were included in the study, whereas patients with inconclusive angiography reports were excluded from the study. Study Procedure A total of 2849 patients were enrolled in the study. Registered angiographic records of the patients were analysed and recorded using a predesigned template. Angiographic videos of patients with coronary anomalies, stored in the catheterisation lab, either on Personalised Computer (PC) or Compact Disc (CD) format, were thoroughly reviewed by two cardiologists. Coronary anomalies were Detected during review and classified as follows: Group A- Anomalies of origination and course, •฀ Group B- Anomalies of coronary termination, •฀ Keywords: Arrhythmia, Cardioembolic events, Epicardial coronary artery