Coronary artery anomalies (CAA) are anatomical abnormalities, usually congenital, that affect the origin, course, and termination of one of the three main epicardial coronary arteries.These may lead to adverse outcomes such as myocardial ischemia, heart failure, coronary artery disease and/or sudden death.Since their first descriptions to the present day, and thanks to the development of new technologies, more information and better characterization of these anomalies has been obtained, requiring that the original classifications be revised and updated.The aim of this article is to propose a possible new classification that combines anatomical features and the degree of clinical significance to try to achieve a better understanding, and thus facilitate the clinical choice of treatment.A narrative review was performed and cases from our experience are included.