{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T15:01:02Z","timestamp":1790002862512,"version":"4.0.1"},"reference-count":18,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The clinical and procedural implications of coronary artery anomalies (CAAs) remain incompletely defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To evaluate the association between anomalous coronary anatomy, obstructive coronary artery disease (CAD), and procedural complexity during coronary angiography and percutaneous coronary intervention (PCI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective single\u2010center study, all patients who underwent coronary angiography between 2014 and 2025 were screened. Among 9567 angiograms, 134 patients (1.4%) had CAAs of origin\/course or termination (excluding myocardial bridges). A vessel\u2010level data set was constructed, and obstructive CAD (\u2265\u200950% stenosis) was compared between anomalous and non\u2010anomalous arteries using clustered logistic regression.<\/jats:p>\n                    <jats:p>Fluoroscopy time, contrast volume, catheter selection, and selective cannulation success were evaluated using multivariable and descriptive analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 134 cases, 53 were anomalies of origin (52 from the aorta and 1 from the pulmonary artery), 51 were variants of origin (28 separate LAD and LCx ostia, 21 anterior RCA take\u2010offs, and 2 high take\u2010offs of the left coronary artery), and 30 were anomalies of termination (27 coronary\u2013pulmonary artery fistulas, 1 coronary\u2013cardiac chamber fistula, and 2 coronary\u2013venous fistulas). Obstructive CAD was more frequent in anomalous versus non\u2010anomalous arteries (33.9% vs. 24.2%) and remained independently associated with anomalous anatomy (OR 1.61, 95% CI 1.15\u20132.26;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006). Catheterization of anomalies of origin was independently associated with longer fluoroscopy time (+3.72\u2009min;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0015) and higher contrast use (+49.6\u2009mL;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). PCI involving anomalous arteries required longer fluoroscopy time compared with PCI of non\u2010anomalous vessels (median 14.6 vs. 8.4\u2009min;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.033).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Anomalous coronary arteries are associated with increased vessel\u2010level prevalence of obstructive CAD and greater procedural complexity, particularly in anomalies of origin.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70880","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:08:18Z","timestamp":1789999698000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Coronary Artery Anomalies, Obstructive Coronary Disease, and Procedural Complexity During Coronary Angiography"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0109-1525","authenticated-orcid":false,"given":"Rozen","family":"Grigorov","sequence":"first","affiliation":[{"name":"Interventional Cardiology Clinic St. Marina University Hospital Varna Bulgaria"},{"name":"First Department of Internal Diseases Medical University of Varna Varna Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2555-2680","authenticated-orcid":false,"given":"Stefan","family":"Yambolov","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Clinic St. Marina University Hospital Varna Bulgaria"},{"name":"First Department of Internal Diseases Medical University of Varna Varna Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivaylo","family":"Borisov","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Clinic St. Marina University Hospital Varna Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3365-427X","authenticated-orcid":false,"given":"Nikolai","family":"Nikolov","sequence":"additional","affiliation":[{"name":"Medical University of Varna Varna Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svetoslav","family":"Georgiev","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Clinic St. Marina University Hospital Varna Bulgaria"},{"name":"First Department of Internal Diseases Medical University of Varna Varna Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"issue":"4","key":"e_1_2_13_2_1","first-page":"271","article-title":"Coronary Artery Anomalies\u2014Current Clinical Issues: Definitions, Classification, Incidence, Clinical Relevance, and Treatment Guidelines","volume":"29","author":"Angelini P.","year":"2002","journal-title":"Texas Heart Institute Journal"},{"key":"e_1_2_13_3_1","first-page":"27","volume-title":"Coronary Artery Anomalies: A Comprehensive Approach","author":"Angelini P.","year":"1999"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra022783"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.02.062"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.14740\/cr941"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.21608\/zumj.2017.4448"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.21088\/jcms.2454.7123.3217.14"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.carrev.2024.09.007"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-026-06037-8"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0167-5273(92)90148-v"},{"issue":"3","key":"e_1_2_13_12_1","first-page":"166","article-title":"Coronary Artery Anomalies: A Review of More Than 10,000 Patients From the Clayton Cardiovascular Laboratories","volume":"15","author":"Wilkins C. 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