Intramural coronary arteries indicative of vascular complications

Intramural coronary arteries (ICA), especially deep-type, are positively associated with insignificant stenosis proximal to ICA, report researchers.

By contrast, superficial ICA is negatively associated with significant stenosis proximal to ICA and predicts an improved prognosis in coronary artery disease (CAD) patients, report Yibo Wang (Chinese Academy of Medical Sciences, Beijing) and colleagues.

They found that the majority (66.3%) of ICAs in a cohort of 261 individuals with ICA in the left anterior descending artery had superficial ICA. ICA was positively associated with insignificant stenosis, at odds ratios (ORs) of 2.06, 3.31, and 1.64 for overall, deep, and superficial ICA, respectively.

By contrast, ICA was negatively associated with significant stenosis, at ORs of 0.56, 0.41, and 0.99 for overall, deep, and superficial ICA, respectively. However, the negative association between ICA and superficial ICA was nonsignificant.

The researchers note in Arteriosclerosis, Thrombosis and Vascular Biology that the depth and location of ICA correlated with stenosis.

Total ICA predicted a significantly lower incidence of major cardiac events including cardiovascular death, myocardial infarction, and revascularization, at an OR of 0.59, while superficial ICA predicted it at an OR of 0.53.

The researchers used multidetector computed tomography coronary angiography to assess ICA and coronary stenosis. Coronary stenosis was classified as nonstenosis, insignificant stenosis (<50%), and significant stenosis (≥50%).

"To our knowledge, this is the first clinical investigation clearly demonstrating that ICA, especially superficial type, is a benign anatomic variant of coronary artery both in normal controls and in CAD patients," write the authors.

They acknowledge that as all the participants in the study were recruited from a single center, the study sample may not be representative of the whole population. Moreover, all individuals had suspected to have CAD, which they say is not representative of the general population either. However, they point out a condition such as ICA does not allow for randomization.

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