Abstract
Objective: It is essential to understand whether coronary artery ectasia (CAE) progresses over time because the patients might be under the risk of coronary rupture, and stent implant should be avoided if ectatic changes progress.Methods: A consecutive series of 99 CAE patients who had undergone coronary angiography at least twice were enrolled and followed up for 1–16 years until they received a second angiogram. Subjects were divided into two groups (1–5 vs. 5–16 years of follow-up), then the basic clinical characteristics and coronary artery images were compared over time.Results: (1) All CAE patients exhibited atherosclerosis, and a majority presented with acute myocardial infarction. Most baseline clinical characteristics were relatively stable. (2) Atherosclerosis (indicated by the distribution of stenosis in coronary vessels) and the Gensini scores progressed significantly. Ectasia extent showed minimal changes as indicated by blood vessel involvement, Markis type, coronary blood flow, ectasia diameter, and ectasia length. (3) Multilinear regression analysis revealed that the underlying factors related to stenosis evolution indicated by fold of Gensini score were: longer time interval, lower baseline Gensini score, and higher hypersensitive C-reactive protein concentration. (4) There was a relationship between the ectatic diameter and the extent of stenosis.Conclusions: For CAE patients with atherosclerosis followed for 1–16 years, there was minimal CAE progression, while the atherosclerosis progressed and the ectasia extent was related to degree of stenosis. The results indicate that prevention and treatment of atherosclerotic changes might have more clinical significance than addressing ectatic changes.
Highlights
Coronary artery ectasia (CAE) has been defined as an ectatic artery diameter more than 1.5 times greater than the diameters of the adjacent normal segments [1]
Possible etiologies include enzyme destruction [2], vascular endothelial dysfunction and oxidative stress [13], and genetic factors [14]. It was unclear whether CAE was progressive disease until recently, and in clinical practice one of the major concerns is that CAE patients might be at risk of continuous rapid expansion even the coronary rupture like giant coronary aneurysm [15], and stent implant in the coronary artery should be avoided if ectatic changes progress
The results revealed that: [1] All CAE patients had evidence of atherosclerosis, and a majority presented with acute myocardial infarction (AMI)
Summary
Coronary artery ectasia (CAE) has been defined as an ectatic artery diameter more than 1.5 times greater than the diameters of the adjacent normal segments [1]. Possible etiologies include enzyme destruction [2], vascular endothelial dysfunction and oxidative stress [13], and genetic factors [14] It was unclear whether CAE was progressive disease until recently, and in clinical practice one of the major concerns is that CAE patients might be at risk of continuous rapid expansion even the coronary rupture like giant coronary aneurysm (another major concern was thrombotic event) [15], and stent implant in the coronary artery should be avoided if ectatic changes progress. This selfcontrolled retrospective cohort study evaluated patient medical records and images from two separate CAG sessions to evaluate dynamic changes of CAE over time
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