Key result
Steal-prone coronary anatomy was present in 23% of 16,249 patients with coronary artery disease in the CASS Registry.
Cross-Sectional (n=16,249)
Almost a quarter of patients with coronary artery disease have steal-prone coronary anatomy, highlighting a significant subset of patients potentially at risk for coronary steal during anesthesia.
Prevalence of steal-prone anatomy may inform anesthetic planning in CAD; leaves open whether targeted strategies affect perioperative outcomes.
Coronary steal requires a specific anatomic arrangement of coronary occlusion, collateral vessels, and stenosis of the artery supplying the collaterals. The prevalence of this anatomic variant, steal-prone coronary anatomy, was investigated in 16,249 patients with coronary artery disease whose angiograms were carefully recorded as part of the Coronary Artery Surgery Study (CASS). Almost half of the angiograms had one or more total occlusions, and, of these, about 80% had angiographically visible collateral supply to the area distal to the occlusion. Of subjects with an occlusion and collaterals, about 60% had a hemodynamically significant stenosis of the artery supplying the collateral vessels. In summary, 23% of the patients in the CASS Registry demonstrated steal-prone coronary anatomy. Thus, coronary steal could possibly affect almost a quarter of the patients with coronary artery disease having anesthesia. Studies that seek clinical evidence of harm from coronary steal must be done in that subset of patients with coronary artery disease with steal-prone anatomy.
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Buffington et al. (1988) conducted a cross-sectional in Coronary artery disease (n=16,249). Steal-prone coronary anatomy was evaluated on Prevalence of steal-prone coronary anatomy. Steal-prone coronary anatomy was present in 23% of 16,249 patients with coronary artery disease in the CASS Registry.