Structural and Functional Intersection: A Case of ACS with Anomalous Left Circumflex Artery

Abstract

Acute Coronary Syndrome (ACS) and coronary artery anomalies are both major contributors to cardiovascular morbidity and mortality. While ACS is commonly due to atherosclerotic processes, coronary artery anomalies (CAA) are relatively rare, occurring in approximately 0.6–1.3% of patients undergoing coronary angiography, but can lead to significant complications such as myocardial ischemia, arrhythmias, and sudden cardiac death (Harky, A., et al).. The intersection of these two conditions presents unique diagnostic and therapeutic challenges. We report the case of a 56-year-old patient, who presented with chest pain and ECG changes consistent with an ST-elevation myocardial infarction (STEMI), and upon further investigation, Coronary angiography revealed a dominant right coronary artery and a retroaortic anomalous LCx originating from the right coronary sinus. The patient underwent successful PCI and was discharged in stable condition with long-term follow-up. The patient underwent successful PCI and was discharged on the fourth day post-procedure and has remained stable over a 6-month follow-up period. This article underscores the importance of considering coronary anomalies in patients presenting with ACS, while shedding light on the complexity of managing such intersecting risks, it also reviews the current literature on the coexistence of ACS and coronary artery anomalies, highlighting recent developments in diagnosis and treatment strategies.