We read with great interest the case report by Dziarmaga et al. titled “Acute inferolateral myocardial infarction in a double right coronary artery”. The authors highlight the rare anatomical variant of a double right coronary artery (RCA) originating from separate ostia, emphasizing that such variants may be overlooked during standard coronary angiography [1]. They further stress that this anomaly should be suspected when coronary angiographic findings are inconclusive [2] or inconsistent with non-invasive imaging results.
Coronary artery anomalies occur in approximately 0.4% to 1.4% of the general population [3]. These anomalies remain one of the most perplexing topics in cardiology and, if not identified, can present challenges for both interventional cardiologists and cardiac surgeons.
There is ongoing debate regarding the definition and prevalence of double RCA. Early case reports and reviews, especially those from Turkey, have suggested a higher frequency among males and a potential genetic predisposition [4, 5].
In a comprehensive review, Moraitis et al. examined over 50 retrospective case reports and small case series investigating the prevalence and clinical features of double RCA. They also presented two additional cases, one of which was detected intraoperatively. The authors argue that this condition may be significantly underreported, stating that “a relatively common anomaly is rarely published” [6].
Various definitions and classifications have been proposed for double RCA, but none have gained widespread acceptance. Due to the potential for this anomaly to be missed on conventional coronary angiography, there is a clear need for large-scale studies using coronary computed tomography angiography as the primary diagnostic modality.
