Clinical Outcomes of Anomalous Aortic Origin of Right Coronary Artery from the Left Coronary Sinus

INTRODUCTION: Anomalous Aortic Origin of Right Coronary Artery (AAORCA) is a rare congenital anomaly that may be associated with adverse cardiac events, including sudden cardiac death. Surgical correction is commonly recommended in patients with AAORCA. Coronary computed tomography angiography (CCTA) is a prevalent diagnostic modality, which increases AAORCA detection. However, the clinical significance of incidentally detected AAORCA remains unclear. METHODS: This non-randomized retrospective analysis included 10,134 patients who underwent CCTA between January 2014 and December 2022, either for suspected coronary artery disease (CAD) or a medical check-up. Three groups were created: patients with normal coronary anatomy (normal), with AAORCA (anomaly), and CAD without AAORCA (CAD). CAD was defined as a percentage diameter stenosis of ≥50% in one or more segments. Cardiac mortality was this study's primary endpoint. RESULTS: Normal, anomaly, and CAD group comprised 7592 (74.9%), 66 (0.7%), and 2476 (24.4%) patients, respectively. During a median follow-up of 33.7 months (IQR: 13.2-53.4), Kaplan-Meier analysis revealed no significant difference in the cardiac death occurrence between the normal (15 events, 0.2%) and anomaly groups (0 events, 0%) (log-rank p=0.685). Cox proportional hazards model revealed no difference in mortality in the anomaly group compared with normal group. CONCLUSIONS: In our cohort, incidentally detected AAORCA in adults did not demonstrate a clearly elevated cardiac death risk relative to CAD during mid-term follow-up. However, given the small number of events, these findings should be interpreted as descriptive rather than confirmatory evidence of a benign natural course, particularly in populations at higher risk of exertional sudden cardiac death.