Coronary tortuosity (CT) is a common anatomical finding during coronary angiography (CA); however, its aetiology and clinical importance have not been clearly defined. We aimed to evaluate the effect of the presence or severity of CT and effect of the sigma-shaped right coronary artery (RCA) on the exercise stress test (EST). Methods: The study included 175 patients who underwent CA due to cardiac symptoms and positive EST and had no obstructive coronary artery disease in a single centre

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... 2017 and 2018 June. The patients were divided into two groups: Group 1, patients with CT (n=88), and group 2, patients without CT (n=87). The patients were also categorised as low and moderate-to-high risk based on Duke treadmill score (DTS). Results: The running distance and DTS were lower, and the rate of sigma-shaped RCA was higher in the CT group (p<0.006). The DTS was lower (p=0.024) in the presence of tortuosity in the left anterior descending coronary artery and negatively influenced as the number of coronary arteries affected by tortuosity increased (p<0.001). Based on the DTS score, patients with moderate-to-high risk have a higher number of vessels affected by tortuosity, involvement of left anterior descending coronary artery, and proportion of sigma-shaped RCA (p<0.001). Conclusion: In the presence of CT, the rate of positivity is significantly higher, and the DTS is lower in the stress test. ABSTRACT ÖZ