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

Koppel, C.J.; Driesen, B.W.; Winter, R.J. de; Bosch, A.E. van den; Kimmenade, R. van; Wagenaar, L.J.; ... ; Vliegen, H.W. (2021)

Article / Letter to editor

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.

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

• All authors: Koppel, C.J.; Driesen, B.W.; Winter, R.J. de; Bosch, A.E. van den; Kimmenade, R. van; Wagenaar, L.J.; Jukema, J.W.; Hazekamp, M.G.; Kley, F. van der; Jongbloed, M.R.M.; Kies, P.; Egorova, A.D.; Verheijen, D.B.H.; Damman, P.; Schoof, P.H.; Wilschut, J.; Stoel, M.; Speekenbrink, R.G.H.; Voskuil, M.; Vliegen, H.W.
• Date: 2021-03-08
• Journal: Netherlands Heart Journal
• Volume: 29
• Issue: 6
• Pages: 311 - 317
• DOI: doi:10.1007/s12471-021-01556-9
• Link: https://link.springer.com/content/pdf/10.1007/s12471-021-01556-9.pdf