Conservative management of ACAOS-IAC yields comparable survival benefit as invasive treatment

Adults with anomalous coronary artery originating from the opposite sinus of Vasalva with interarterial course (ACAOS-IAC) benefit from both revascularization and noninvasive management, a new study has found.

Researchers conducted a retrospective observational analysis of 40 ACAOS-IAC patients (mean age 51 years) whose medical records were reviewed for management approach, mortality, cardiac deaths, and associated adverse events.

All but one patient (98 percent) did not undergo revascularization with regard to the coronary anomaly and had no restrictions on physical activities; one patient needed emergency percutaneous coronary intervention (PCI).

Over an average follow-up of 2.7 years, the researchers recorded no cases of cardiovascular death. On the other hand, one patient (3 percent) died. Autopsy showed major cerebral infarction on the left hemisphere. Two patients (6 percent) experienced coronary-related adverse events.

The researchers then conducted a systematic literature review, including 19 related studies with 1,194 ACAOS-IAC patients. Nearly a third of these participants underwent revascularization, including surgical repair and PCI. Stratifying mortality analysis according to clinical management revealed low death rates for patients who did (6.3 percent) and did not (5.3 percent) undergo revascularization.

“Adults are believed to have a better prognosis than young patients when presenting with an ACAOS-IAC. Management with revascularization in adults is therefore debatable,” the researchers said.

“Long follow-up is needed to demonstrate the contributing role of revascularization in adults with ACAOS-IAC,” they added.