Abstract
Our purpose was to assess a possible association of inflammatory, lipid and mineral metabolism biomarkers with coronary artery ectasia (CAE) and to determine a possible association of this with acute atherotrombotic events (AAT). We studied 270 patients who underwent coronary angiography during an acute coronary syndrome 6 months before. Plasma levels of several biomarkers were assessed, and patients were followed during a median of 5.35 (3.88–6.65) years. Two interventional cardiologists reviewed the coronary angiograms, diagnosing CAE according to previously published criteria in 23 patients (8.5%). Multivariate binary logistic regression analysis was used to search for independent predictors of CAE. Multivariate analysis revealed that, aside from gender and a diagnosis of dyslipidemia, only monocyte chemoattractant protein-1 (MCP-1) (OR = 2.25, 95%CI = (1.35–3.76) for each increase of 100 pg/mL, p = 0.001) was independent predictor of CAE, whereas mineral metabolism markers or proprotein convertase subtilisin/kexin type 9 were not. Moreover, CAE was a strong predictor of AAT during follow-up after adjustment for other clinically relevant variables (HR = 2.67, 95%CI = (1.22–5.82), p = 0.013). This is the first report showing that MCP-1 is an independent predictor of CAE, suggesting that CAE and coronary artery disease may share pathogenic mechanisms. Furthermore, CAE was associated with an increased incidence of AAT.
Highlights
Coronary artery ectasia (CAE) is a characteristic disorder of the coronary arteries, with a prevalence of 0.2–5% in patients undergoing cardiac catheterization [1,2,3,4]
The present work is a sub-study of The Biomarkers in Acute Coronary Syndrome (BACS) and Biomarkers in Acute Myocardial Infarction (BAMI) studies that included patients with non-ST-elevation acute coronary syndrome (NSTEACS) or ST-elevation myocardial infarction (STEMI)
We explored the potential role of proprotein convertase subtilisin/kexin type 9 (PCSK9) in the genesis of coronary artery ectasia (CAE), but we did not find any significant relationship with its plasma levels
Summary
Coronary artery ectasia (CAE) is a characteristic disorder of the coronary arteries, with a prevalence of 0.2–5% in patients undergoing cardiac catheterization [1,2,3,4]. Angiographic findings suggestive of CAE comprise segmental or diffuse dilatation of one or several coronary arteries, with slow and turbulent flow. Patients diagnosed with CAE are prone to exercise-induced angina and acute atherotrombotic events (AAE) regardless of the degree of stenotic coronary artery disease (CAD). It has been related to atherosclerosis, congenital disorders, Kawasaki disease, and aneurysms in other territories, it is difficult to differentiate among these types in the clinical setting [6,7,8,9]. Classical studies showed similar histological changes to those of severe atherosclerosis, other patients presented smooth muscle hyalinization of the coronary media layer [6,10]. Inflammation could play a role in CAE development, as these patients present higher plasmatic levels of cytokines (interleukin-6 and tumor necrosis factor), inflammatory cells (leucocytes, monocytes), high sensitivity C-reactive protein (hs-CRP), soluble adhesion molecules, and neutrophil gelatinase-associated lipocalin (NGAL) [11,12,13,14,15,16]
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