Prevalence, risk factors, and coronary angiographic profile in patients with tortuous coronary artery

Background: Tortuosity of the coronary arteries (CT) is a common finding during coronary artery catheterization. Although coronary tortuosity is seen frequently on coronary angiography in patients with chest pain, it is rarely reported as it is unclear whether there is a functional significance of this finding or not. Some researches define CT as >= 3 consecutive curvatures of 45 degrees or more in at least one coronary bed. Objectives: The aim of our study was to determine the prevalence of CT among patients who underwent coronary angiography at Cairo University. Hospitals with specific emphasis on the clinical presentation, traditional risk factors of coronary artery disease and coronary angiographic severity studied by Gensini and vessel scores. Patients and methods: This retrospective longitudinal study was conducted from November 2018 to April 2019. Among 788 patients who underwent coronary angiography to rule out CAD, two hundred patients were enrolled (100 with CT and 100 without). We reviewed all patients' coronary angiography reports to include 100 tortuous coronary cases. Hundred patients without CT were enrolled as controls. Thorough history taking and clinical examination was done for all patients. Diagnostic coronary angiography was performed via a femoral or radial approach. Angiograms were analyzed offline by a cardiologist, blinded to the medical history. CT was identified by >= 3 bends (defined as >= 45 degrees change in vessel direction) along the main trunk of at least one artery, present both in systole and diastole. Gensini and vessel scores were calculated. The data collected were entered and analyzed using IBM Statistical Package for Social Science (SPSS) software version 23. Results: The prevalence of CT was 12.7%. Age more than 65 years and female gender were positively correlated with CT. Hypertension was more common in patients with CT than those without (74% vs. 48%) (p<0.001). Left circumflex artery (LCX) was mostly affected by tortuosity (52%) then left anterior descending (20%). The tortuous segment had less atherosclerotic stenosis than the non-tortuous segment. Gensini and vessel scores were higher in non-tortuous coronary arteries group. Prevalence of CAD in patients with CT was 48% versus 52% in patients without tortuous coronary arteries. Conclusion: Patients with CT without coronary artery atherosclerotic stenosis may present with symptoms like typical chest pain. CT is positively correlated with hypertension and female gender but negatively related to CAD. Patients with CT may present with symptoms like typical chest pain yet without coronary artery stenosis. LCX is more affected by tortuosity than other coronary artery. Gensini and vessel scores were higher in non-tortuous coronary artery (NTCA) group.