One-Year Outcome of Patients with Coronary Artery Ectasia Undergoing Percutaneous Coronary Intervention: Clinical Implications and Question Marks
Background: Coronary artery ectasia (CAE) is a rare condition with unclear pathophysiology, optimal treatment, and prognosis. We aimed to determine the prognostic implications of CAE following coronary angioplasty.
Methods: We conducted a retrospective cohort study on 385 patients, including 87 subjects with CAE, who underwent percutaneous coronary intervention (PCI). Major adverse cardiovascular events (MACE) were considered to consist of mortality, nonfatal myocardial infarction (MI), repeated revascularization, and stroke.
Results: The mean age of the participants was 57.31±6.70 years. Multivariate regression analysis revealed that patients with diabetes, ST-segment–elevation MI at presentation, and high thrombus grades were more likely to have suboptimal post-PCI thrombolysis in myocardial infarction (TIMI) flow. However, CAE was not a predictor of a decreased TIMI flow (OR: 1.46, 95% CI: 0.78–8.32; P=0.391). The Cox-regression model showed that CAE, the body mass index, and a family history of MI were risk factors for MACE, while short lesion lengths (<20 vs >20 mm) had an inverse relationship. The adjusted hazard ratio (HR) for the prediction of MACE in the presence of CAE was 1.65 (95% CI: 1.08–4.78; P=0.391). All-cause mortality (HR: 1.69, 95% CI: 0.12–3.81; P=0.830) and nonfatal MI (HR: 1.03, 95% CI: 0.72–4.21; P=0.341) occurred similarly in the CAE and non-CAE groups. Conversely, CAE increased urgent repeat revascularization (HR: 2.40; 95% CI: 1.13–5.86; P=0.013).
Conclusion: Although CAE had no substantial short-term prognostic effects on post-PCI TIMI flow, considerable concerns regarding adverse outcomes emerged during our extended follow-up. Stringent follow-ups of these patients should be underscored due to the high likelihood of urgent revascularization.
2. Tunick PA, Slater J, Kronzon I, Glassman E. Discrete atherosclerotic coronary artery aneurysms: a study of 20 patients. J Am Coll Cardiol 1990;15:279-282.
3. Giannoglou GD, Antoniadis AP, Chatzizisis YS, Damvopoulou E, Parcharidis GE, Louridas GE. Prevalence of ectasia in human coronary arteries in patients in northern Greece referred for coronary angiography. Am J Cardiol 2006;98:314-318.
4. Almansori MA, Elsayed HA. Coronary artery ectasia - a sample from Saudi Arabia. J Saudi Heart Assoc 2015;27:160-163.
5. Abou Sherif S, Ozden Tok O, Taşköylü Ö, Goktekin O, Kilic ID. Coronary artery aneurysms: a review of the epidemiology, pathophysiology, diagnosis, and treatment. Front Cardiovasc Med 2017;4:24.
6. Zografos TA, Korovesis S, Giazitzoglou E, Kokladi M, Venetsanakos I, Paxinos G, Fragakis N, Katritsis DG. Clinical and angiographic characteristics of patients with coronary artery ectasia. Int J Cardiol 2013;167:1536-1541.
7. Demopoulos VP, Olympios CD, Fakiolas CN, Pissimissis EG, Economides NM, Adamopoulou E, Foussas SG, Cokkinos DV. The natural history of aneurysmal coronary artery disease. Heart 1997;78:136-141.
8. Markis JE, Joffe CD, Cohn PF, Feen DJ, Herman MV, Gorlin R. Clinical significance of coronary arterial ectasia. Am J Cardiol 1976;37:217-222.
9. Krüger D, Stierle U, Herrmann G, Simon R, Sheikhzadeh A. Exercise-induced myocardial ischemia in isolated coronary artery ectasias and aneurysms ("dilated coronopathy"). J Am Coll Cardiol 1999;34:1461-1470.
10. Rath S, Har-Zahav Y, Battler A, Agranat O, Rotstein Z, Rabinowitz B, Neufeld HN. Fate of nonobstructive aneurysmatic coronary artery disease: angiographic and clinical follow-up report. Am Heart J 1985;109:785-791.
11. Furugen M, Takagawa Y. Staged interventional management of a massive thrombus related to coronary artery ectasia in acute coronary syndrome. Cardiovasc Interv Ther 2012;27:57-61.
12. Anabtawi IN, de Leon JA. Arteriosclerotic aneurysms of the coronary arteries. J Thorac Cardiovasc Surg 1974;68:226-228.
13. Appleby MA, Angeja BG, Dauterman K, Gibson CM. Angiographic assessment of myocardial perfusion: TIMI myocardial perfusion (TMP) grading system. Heart 2001;86:485-486.
14. Gunes Y, Boztosun B, Yildiz A, Metin Esen A, Saglam M, Bulut M, Karapinar H, Kirma C. Clinical profile and outcome of coronary artery ectasia. Heart 2006;92:1159-1160.
15. Zhang Y, Huang QJ, Li XL, Guo YL, Zhu CG, Wang XW, Xu B, Gao RL, Li JJ. Prognostic value of coronary artery stenoses, Markis class, and ectasia ratio in patients with coronary artery ectasia. Cardiology 2015;131:251-259.
16. Evrengül H, Çelek T, Tanrıverdi H, Kaftan A, Dursunoğlu D, Kılıç M. The effect of preinfarction angina on clinical reperfusion time in patients with acute myocardial infarction receiving successful thrombolytic therapy. Can J Cardiol 2005;21:915-920.
17. Karabulut A, Cakmak M, Uzunlar B. Association between preinfarction angina and coronary artery ectasia in the acute myocardial infarction. Acta Cardiol 2011;66:509-514.
18. Boles U, Rakhit R, Shiu MF, Patel K, Henein M. Coronary artery ectasia as a culprit for acute myocardial infarction: review of pathophysiology and management. Anadolu Kardiyol Derg 2013;13:695-701.
19. Montalescot G, Barragan P, Wittenberg O, Ecollan P, Elhadad S, Villain P, Boulenc JM, Morice MC, Maillard L, Pansiéri M, Choussat R, Pinton P; ADMIRAL Investigators. Abciximab before direct angioplasty and stenting in myocardial infarction regarding acute and long-term follow-up. Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction. N Engl J Med 2001;344:1895-1903.
20. Bogana Shanmugam V, Psaltis PJ, T L Wong D, T Meredith I, Malaiapan Y, Ahmar W. Outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction caused by ectatic infarct related arteries. Heart Lung Circ 2017;26:1059-1068.
21. Durante A, Camici PG. Novel insights into an "old" phenomenon: the no reflow. Int J Cardiol 2015;187:273-280.
22. Ashoori A, Pourhosseini H, Ghodsi S, Salarifar M, Nematipour E, Alidoosti M, Haji-Zeinali AM, Nozari Y, Amirzadegan A, Aghajani H, Jalali A, Hosseini Z, Jenab Y, Geraiely B, Omidi N. CHA2DS2-VASc score as an independent predictor of suboptimal reperfusion and short-term mortality after primary PCI in patients with acute ST segment elevation myocardial infarction. Medicina (Kaunas) 2019;55:35.
23. Schram HCF, Hemradj VV, Hermanides RS, Kedhi E, Ottervanger JP; Zwolle Myocardial Infarction Study Group. Coronary artery ectasia, an independent predictor of no-reflow after primary PCI for ST-elevation myocardial infarction. Int J Cardiol 2018;265:12-17.
|Issue||Vol 15 No 4 (2020): J Teh Univ Heart Ctr|
|Coronary artery disease Percutaneous coronary intervention Dilatation; pathologic Mortality Prognosis|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|