Distinct clinical profile of patients with anomalous coronary arteries: insights from a single-center cohort

Background Anomalous coronary arteries from the opposite sinus (ACAOS) are uncommon but clinically relevant findings that may present with acute ischemic symptoms or be detected incidentally. Purpose To characterize the clinical features and short-term outcomes of patients with ACAOS admitted to an acute coronary care facility. Methods We conducted a retrospecitve cohort study including patients aged >18 years diagnosed with ACAOS in our center. Continuous variables are summarized as mean ± SD or median (IQR); categorical variables as n (%). Results A total of 37 patients were included hospitalized in our center from 2015 to 2023. The mean age was in the late 40s, BMI was in the overweight range, and left ventricular ejection fraction was preserved (~50%). Coronary calcium scores were low or zero, consistent with a young, predominantly non-atherosclerotic population. Right coronary dominance was common, and the most frequent anomaly was right coronary artery arising from the left sinus (right-from-left ACAOS). In our cohort, the following events were observed: infarction in 7/37 (18.9%), recurrent angina in 5/37 (13.5%), and cardiac insufficiency in 4/37 (10.8%). Conclusions In this single-center cohort, right-from-left ACAOS was the predominant subtype and affected relatively young, non-atherosclerotic patients who nonetheless presented with significant ischemic events. These findings highlight the need for high clinical suspicion and structured evaluation of ACAOS in acute coronary settings. Clinical profile of patients with ACAOS