Prevalence and Long-term Outcomes of Patients with Coronary Artery Ectasia Presenting with Acute Myocardial Infarction

Xu Wang,Jose M Montero-Cabezas,Alessandro Mandurino-Mirizzi,Kensuke Hirasawa,Nina Ajmone Marsan,Juhani Knuuti,Jeroen J Bax,Victoria Delgado

doi:10.1016/j.amjcard.2021.06.037

Abstract

Coronary artery ectasia (CAE) is described in 5% of patients undergoing coronary angiography. Previous studies have shown controversial results regarding the prognostic impact of CAE. The prevalence and prognostic value of CAE in patients with acute myocardial infarction (AMI) remain unknown. In 4788 patients presenting with AMI referred for coronary angiography the presence of CAE (defined as dilation of a coronary segment with a diameter ≥1.5 times of the adjacent normal segment) was confirmed in 174 (3.6%) patients (age 62 ± 12 years; 81% male), and was present in the culprit vessel in 79.9%. Multivessel CAE was frequent (67%). CAE patients were more frequently male, had high thrombus burden and were treated more often with thrombectomy and less often was stent implantation. Markis I was the most frequent angiographic phenotype (43%). During a median follow-up of 4 years (1-7), 1243 patients (26%) experienced a major adverse cardiovascular event (MACE): 282 (6%) died from a cardiac cause, 358 (8%) had a myocardial infarction, 945 (20%) underwent coronary revascularization and 58 (1%) presented with a stroke. Patients with CAE showed higher rates of MACE as compared to those without CAE (36.8% versus 25.6%; p <0.001). On multivariable analysis, CAE was associated with MACE (HR 1.597; 95% CI 1.238-2.060; p <0.001) after adjusting for risk factors, type of AMI and number of narrowed coronary arteries. In conclusion, the prevalence of CAE in patients presenting with AMI is relatively low but was independently associated with an increased risk of MACE at follow-up.

Highlights

Which showed contradictory results.[5,6,7,8,9] we aimed at: 1) assessing the prevalence of Coronary artery ectasia (CAE) in a large cohort of patients presenting with acute myocardial infarction (AMI), 2) defining the main phenotypical angiographic characteristics of patients with and without CAE and 3) at investigating the long-term prognostic impact of CAE
The prevalence of CAE in a large cohort of patients presenting with AMI was 3.6%
Patients with CAE presented with ectasia affecting 2 or more coronary arteries in 67%

Summary

Methods

Consecutive patients presenting with AMI at the Leiden University Medical Center (Leiden, the Netherlands) between February 2004 to October 2015, who underwent acute invasive coronary angiography, were included in the analysis. Baseline demographic and clinical data, including cardiovascular risk factors and medications at discharge, were retrospectively collected from the Departmental Cardiology Information System (EPD-Vision: Leiden University Medical Center, Leiden, The Netherlands). This retrospective study of clinically acquired data was approved by the Institutional Review Board and the need for patient written informed consent was waived. Patients were followed-up according to the institutional guideline-based care-track protocol.[10] The primary endpoint was composite of major adverse cardiovascular events (MACE) which included cardiac death, myocardial infarction, stroke and repeated coronary revascularization, including percutaneous coronary intervention or coronary artery bypass grafting.

Results

II III IV Large thrombus burden

Discussion

Disclosures