{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T11:51:53Z","timestamp":1792065113897,"version":"4.4.0"},"reference-count":23,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,5,12]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Coronary artery fistulas (CAFs) are rare congenital or acquired anomalies characterised by abnormal coronary communications, with variable natural history and no consensus on optimal management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive state-of-the-art review and pooled analysis of published literature was conducted, integrating clinical, anatomical, imaging, management and outcome data from 1966 patients with 1986 CAFs. Comparative descriptive analyses between complicated and uncomplicated cases were performed to identify recurring features associated with adverse clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Specific anatomical and clinical patterns were more frequently observed in patients with complications, including fistulas originating from the right coronary artery or left main coronary artery, drainage into venous or left-sided structures, large-calibre fistulas and reduced ventricular function. Based on these recurring patterns, two pragmatic phenotypes of CAFs (higher-risk and lower-risk) were identified. Given the descriptive nature of the available evidence and the absence of formal multivariable modelling, these findings should be considered hypothesis-generating rather than indicative of independent predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CAFs are heterogeneous vascular anomalies with variable clinical presentation and substantial potential for complications. An integrated assessment of anatomical configuration, fistula size, drainage pattern and ventricular function may support structured clinical evaluation and individualised management. We propose a practical anatomy- and risk-informed framework to guide multidisciplinary decision-making and follow-up strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004055","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T13:40:22Z","timestamp":1783518022000},"page":"e004055","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Coronary artery fistulas: a systematic review and pooled analysis of anatomy, risk stratification and contemporary management"],"prefix":"10.1136","volume":"13","author":[{"given":"Mattia","family":"Vinciguerra","sequence":"first","affiliation":[{"name":"Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy"},{"name":"Department of Health and Life Sciences, European University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Pisani","sequence":"additional","affiliation":[{"name":"Department of Clinical, Internal Medicine, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Caldaroni","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Garofalo","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, S. G. Moscati Hospital, Avellino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlene","family":"Tennyson","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Washington DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukesh","family":"Karuppannan","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scot","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Blackburn Teaching Hospital, Blackburn, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"D\u2019Ambrosio","sequence":"additional","affiliation":[{"name":"Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (IS), Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Saltarocchi","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Surgical Specialty and Anesthesiology \u201cParide Stefanini\u201d, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3909-182X","authenticated-orcid":false,"given":"Mattia","family":"Galli","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy"},{"name":"IRCCS Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Schirone","sequence":"additional","affiliation":[{"name":"Department of Health and Life Sciences, European University of Rome, Rome, Italy"},{"name":"Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli (IS), Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"Greco","sequence":"additional","affiliation":[{"name":"Department of Health and Life Sciences, European University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiano","family":"Spadaccio","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7616-6283","authenticated-orcid":false,"given":"David","family":"Rose","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK"},{"name":"Lancaster University, Lancaster, 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