Coronary artery anomalies (CAAs) are a group of congenital conditions characterized by abnormal origin or course of any of the 3 main epicardial coronary arteries. Although CAAs have been identified as a common underlying condition in young athletes with sudden cardiac death, the widespread use of invasive and noninvasive coronary imaging has led to increased recognition of CAAs among adults. CAAS are often discovered as an incidental finding during the diagnostic workup for ischemic heart disease. The clinical correlates and prognostic implication of CAAs remain poorly understood in this context, and guideline-recommended therapeutic choices are supported by a low level of scientific evidence. Several studies have examined whether assessment of CAA-related myocardial ischemia can improve risk stratification in these patients, suggesting that multimodality imaging and functional tests may be key in the management of CAAs. The aim of this review is to outline definitions, classification, and epidemiology of the most relevant CAAs, highlighting recent advances and the potential impact of multimodality evaluation, and to discuss current therapeutic opportunities.

中文翻译：

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冠状动脉异常

冠状动脉异常 (CAA) 是一组先天性疾病，其特征是 3 条主要心外膜冠状动脉中的任何一条的起源或路线异常。尽管 CAA 已被确定为年轻运动员心脏性猝死的常见潜在疾病，但侵入性和非侵入性冠状动脉成像的广泛使用已导致成人对 CAA 的认识增加。CAAS 经常被发现是在缺血性心脏病的诊断检查过程中偶然发现的。在这种情况下，对 CAA 的临床相关性和预后影响仍然知之甚少，指南推荐的治疗选择得到低水平科学证据的支持。几项研究检查了评估 CAA 相关心肌缺血是否可以改善这些患者的风险分层，表明多模态成像和功能测试可能是 CAA 管理的关键。本综述的目的是概述最相关 CAA 的定义、分类和流行病学，突出最近的进展和多模式评估的潜在影响，并讨论当前的治疗机会。