Perspective:

CCTA identifies anatomic details that may not be seen on other cardiovascular tests, and the frequent identification of an intramural coronary artery is one example of this. Only cases with significant constriction of the arterial lumen by the myocardium are appreciated on invasive coronary angiography, while CCTA can easily visualize any coronary artery that lives within the myocardium. This study finds that these are very common in patients without obstructive CAD, and that their presence is not associated with any difference in intermediate-term adverse events. This study was retrospective, and it is unknown if it was adequately powered to detect a difference in adverse events. Further, it was not able to compare outcomes between subgroups that could be at potentially higher risk (e.g., deeper or longer course, significant systolic compression of the lumen). As there are case reports of adverse events in patients with an intramural coronary artery course, these findings should be evaluated in the context of the individual patient. Nevertheless, this large study is reassuring that intramural coronary arteries detected on CCTA and in the absence of obstructive CAD are associated with a favorable intermediate-term prognosis.