Coronary Artery Variation Phenotypes and Associated Clinical Characteristics in a Libyan Adult Cohort: A Multicentre Imaging Analysis

Authors: Yaseen Ahmad Muhammad Wafi; Emad M.N. Abdelwahab; Lubna Shirin; Mohammed S. Kabir
Coronary Artery Variation Phenotypes and Associated Clinical Characteristics in a Libyan Adult Cohort: A Multicentre Imaging Analysis
DOI
10.25125/imjh-sep-2026-2
DIN
IMJH-SEP-2026-2
Abstract

Background: Coronary artery variations encompass a heterogeneous group of developmental and morphological phenotypes whose clinical expression may differ according to subtype and patient characteristics. Population-specific data from North Africa remain limited.

Methods: This multicentre retrospective cross-sectional study analysed 200 Libyan adults aged 26–85 years who underwent coronary assessment at three referral centres. Coronary artery variation status and phenotype were abstracted from coronary imaging reports together with demographic, anthropometric, cardiovascular risk, and symptom data. Descriptive statistics, chi-square tests, Monte Carlo procedures for sparse contingency tables, Cramér's V, and one-way analysis of variance were used as appropriate.

Results: Coronary artery variations were identified in 87/200 participants (43.5%). Among variation-positive cases, anomalous origin/ostial variants were most frequent (33/87, 37.9%), followed by other/unspecified patterns (17.2%), branching/length variants (14.9%), ectasia/aneurysm (13.8%), myocardial bridging (10.3%), and interarterial/intramural courses (5.7%). Phenotype distribution differed by sex (Monte Carlo p=0.004), whereas no significant association was observed with age band (Monte Carlo p=0.243). Palpitations occurred more frequently in participants with a coronary variation than in those without one (19.5% vs 8.8%; χ²=4.811, p=0.028; V=0.155), although the effect size was small. Mean body mass index did not differ across variation phenotypes (F(5,81)=0.483, p=0.788).

Conclusion: Coronary artery variation phenotypes were common in this clinically referred Libyan cohort and showed distinct sex-related patterns and a modest association with palpitations. Phenotype-level anatomical reporting may add clinically useful information beyond recording the presence or absence of a coronary variation.

Keywords
coronary artery variations; coronary anomalies; coronary anatomy; Libya; coronary imaging; myocardial bridging; palpitations.
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Introduction

Coronary artery variations and anomalies comprise deviations in coronary origin, ostial position, course, branching, length, termination, or vessel morphology, and are commonly classified according to anatomical subtype to aid clinical and imaging interpretation [1,2]. Many are incidental, but selected phenotypes can influence myocardial perfusion, complicate catheter engagement or surgery, and alter procedural planning. Contemporary guidelines therefore emphasize accurate anatomical definition when a clinically relevant anomalous origin or course is suspected [3,4].

Reported prevalence varies markedly according to the population studied, imaging modality, and—critically—the definition used. Large angiographic and CT-based series restricted to congenital anomalies of origin and course generally report prevalence in the low single digits [5,6], whereas broader frameworks that include myocardial bridging, ectasia, branching patterns, and other coronary variants yield substantially higher estimates [7–10]. This definitional heterogeneity makes direct comparison between populations difficult and supports reporting individual phenotypes rather than a single pooled anomaly rate.

Coronary CT angiography (CCTA) provides three-dimensional assessment of coronary origin and course and is particularly useful for defining relationships with the aorta and pulmonary artery. Invasive coronary angiography remains central to the assessment and treatment of obstructive coronary disease but may be less informative for some three-dimensional anatomical relationships [3,4,11]. The increasing use of coronary imaging has consequently expanded recognition of anatomical phenotypes that were previously under-reported.

Evidence describing coronary variation phenotypes in North African populations is limited [12]. The present analysis was designed to characterise the phenotype distribution of coronary artery variations in a multicentre Libyan adult cohort and to examine selected demographic and clinical correlates. To maintain a distinct clinical-anatomical focus, the primary analyses address phenotype, sex, age, body mass index (BMI), and palpitations rather than comparative diagnostic performance between imaging modalities or multivariable prediction of coronary artery disease.

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Conclusion

Coronary artery variations were frequently documented in this clinically referred Libyan adult cohort, with anomalous origin/ostial patterns forming the largest phenotype group. Variation phenotype differed by sex but not significantly by age band, and palpitations were more common among participants with a documented variation. These findings support phenotype-level reporting of coronary anatomy and careful integration of anatomical findings with the patient's clinical presentation.

Larger prospective, sex-balanced studies using standardised coronary variation definitions are needed to establish population-specific prevalence and clinical risk. Future research should also address the limitations identified in this study, particularly the need for standardised imaging protocols, complete anatomical characterisation, and systematic symptom assessment.

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