CLINICAL STATEMENTS AND GUIDELINES being wrong for a young patient with AAOCA may be perceived to be greater than for many other con- ditions. Consequently, there is often a clinical urge to seek a reason to do something like surgical repair, because the available data do not identify clinical fea- tures that provide reassurance that a patient is at low risk of cardiovascular events. Unfortunately, evidence demonstrating that surgical repair ameliorates SCD risk, derived from large enough cohorts followed over a sufficient period of time, is not available. 4.4.7.1. Anomalous Coronary Artery Evaluation Recommendations for Anomalous Coronary Artery Evaluation Referenced studies that support recommendations are summarized in Online Data Supplement 51. COR LOE Recommendations Diagnostic I C-LD Coronary angiography, using catheterization, CT, or CMR, is recommended for evaluation of anomalous I C-LD Anatomic and physiological evaluation should be performed in patients with anomalous aortic origin of the left coronary from the right sinus and/or right coronary from the left sinus.S4.4.7.1-4 S4.4.7.1-9 Recommendation-Specific Supportive Text 1. CTA, CMR, and catheterization can all delineate the proximal course of the coronary artery and relationship to other structures. CTA is generally preferred because it has superior spatial and tem- poral resolution, although CMR may also pro- vide adequate delineation of the relationship of the coronary artery to the aorta, PA and other structures, including whether the proximal course appears to be intramural. Coronary angiography by catheterization can be helpful when there is concern about stenosis in the coronary artery or when concomitant hemodynamic evaluation for shunt assessment or intravascular ultrasonog- raphy/flow evaluation is needed. 2. Assessment of AAOCA is enhanced when the precise anatomy and physiological impact of the coronary artery anomaly are understood. 