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Sudden cardiac death in young individuals is considered a tragedy especially if it is due to a possible preventive problem. The need to establish proper screening protocols in the large athletic and young population cannot be over emphasized. One of more common causes of SCD is the presence of lethal anomalous right coronary artery disease from the left main artery and traversing between the pulmonary trunk and the aortic root now called LRCA.
Using our database from the cardiac CTA department we reviewed a random group of patients with CTA diagnosed anomalous right coronary artery from the left main coronary artery. Patients were divided into two groups, the benign and the lethal variety of patients with anomalous right coronary artery of the LRCA variety again all diagnosed by 64 slice cardiac CTA. We obtained history of presentation, past medical and social history, family history and physical notes, we also obtained ECG and if available exercise ECG, we also obtained list of medications. Parameters obtained from these sources included; demographics i.e. age, sex, race, presenting complaints i.e. chest pain variants of angina, syncope, dizziness, SCD, falls, shortness of breath. Family history included; SCD in family, age of SCD, social history included drug use, alcohol use, tobacco abuse and other substances. The ECG was reviewed at rest and if available post exercise.
Baseline characteristics were similar except for a greater proportion of black males. By logistic regression, factors predictive of presence of lethal variety of anomalous right coronary artery included a history of sudden cardiac death in family, episodes of dizziness and chest, age of range 20-35 and black male. Others include non-specific T wave changes in the inferior lateral leads and t wave inversions on exercise. Each of these variables were given a score based on the regression analysis. This was subsequently applied to the rest of the patients including the original group. Findings are presented.
The LARCALM score predicted the presence of lethal anomalous right coronary artery with a sensitivity of over 50 % and specificity of 30%. Accuracy was also noted to be over 20% in this population. There was no difference in outcomes in patients with the lethal variety on medical therapy, which was beta blocker use and cardiac surgery.