Abstract 18909: Symptoms and Coronary Anatomy are Associated with Management Decisions in Children and Young Adults with Anomalous Aortic Origin of a Coronary Artery: A Congenital Heart Surgeons' Society (CHSS) Study
Bibliographic record
Abstract
Background: Anomalous Aortic Origin of a Coronary Artery (AAOCA) is a rare congenital heart lesion associated with myocardial ischemia and sudden death in the young. Evidence-based criteria for managing young patients with AAOCA are lacking. The CHSS began multi-center enrollment of patients with AAOCA age ≤ 30 years to develop these criteria. We hypothesized that demographics, symptoms and features of coronary morphology would correlate with whether or not the patient had surgery. Methods: To date, we have enrolled 199 patients from 23 CHSS member institutions (median age at diagnosis= 10.4 years; 64% male). Data was extracted from clinical records. Fifty-three percent were symptomatic at presentation (most commonly chest pain, N=78). AAOCA was diagnosed at autopsy in two patients who presented after sudden death (1 with anomalous left coronary artery [ALCA]; 1 with a single ostium above a commissure). Correlation analysis compared demographics, symptoms, coronary anatomy and management. Results: Imaging reports documented anomalous right coronary artery [ARCA] in 142 patients (74%) and ALCA in 51 patients (26%). Surgery was performed in 106 patients (70 ARCA [66%]; 34 ALCA [32%]; 2 ARCA/ALCA [2%]) at a median age of 12.6 years. Overall, 71% of patients with ARCA vs. 51% with ALCA had surgery. Most surgical patients (96/106) had an intramural anomalous coronary artery (69/72 ARCA; 27/36 ALCA). The correlation of diagnostic reports (N=100) with surgical findings was poor (45%). Surgery correlated with symptoms, older age and intramural ALCA (Table). Conclusions: A high index of suspicion for coronary anomalies should be present when a young patient presents with exertional chest pain, presyncope or syncope. Surgical management of these patients is influenced by patient symptoms and coronary morphology. Future analysis of this expanding cohort will lead to evidence-based protocols to manage the spectrum of risk in this heterogeneous population of young patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".