The first multicentre study on coronary anomalies in the Netherlands: MuSCAT

C J Koppel, B W Driesen, R J de Winter, A E van den Bosch, R van Kimmenade, L J Wagenaar, J W Jukema, M G Hazekamp, F van der Kley, M R M Jongbloed, P Kiès, A D Egorova, D B H Verheijen, P Damman, P H Schoof, J Wilschut, M Stoel, R G H Speekenbrink, M Voskuil, H W Vliegen

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Abstract

BACKGROUND: Current guidelines on coronary anomalies are primarily based on expert consensus and a limited number of trials. A gold standard for diagnosis and a consensus on the treatment strategy in this patient group are lacking, especially for patients with an anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) with an interarterial course.

AIM: To provide evidence-substantiated recommendations for diagnostic work-up, treatment and follow-up of patients with anomalous coronary arteries.

METHODS: A clinical care pathway for patients with ACAOS was established by six Dutch centres. Prospectively included patients undergo work-up according to protocol using computed tomography (CT) angiography, ischaemia detection, echocardiography and coronary angiography with intracoronary measurements to assess anatomical and physiological characteristics of the ACAOS. Surgical and functional follow-up results are evaluated by CT angiography, ischaemia detection and a quality-of-life questionnaire. Patient inclusion for the first multicentre study on coronary anomalies in the Netherlands started in 2020 and will continue for at least 3 years with a minimum of 2 years of follow-up. For patients with a right or left coronary artery originating from the pulmonary artery and coronary arteriovenous fistulas a registry is maintained.

RESULTS: Primary outcomes are: (cardiac) death, myocardial ischaemia attributable to the ACAOS, re-intervention after surgery and intervention after initially conservative treatment. The influence of work-up examinations on treatment choice is also evaluated.

CONCLUSIONS: Structural evidence for the appropriate management of patients with coronary anomalies, especially (interarterial) ACAOS, is lacking. By means of a structured care pathway in a multicentre setting, we aim to provide an evidence-based strategy for the diagnostic evaluation and treatment of this patient group.

Original languageEnglish
Pages (from-to)311-317
Number of pages7
JournalNetherlands Heart Journal
Volume29
Issue number6
Early online date8 Mar 2021
DOIs
Publication statusPublished - Jun 2021

Keywords

  • Anomalous coronary artery from the opposite sinus of Valsalva
  • Anomalous coronary artery from the pulmonary artery
  • Coronary anomalies
  • Coronary arteriovenous fistula
  • Multicentre study

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