Long Term Follow-up of Patients with Coronary Artery Ectasia

Introduction:

Coronary artery ectasia (CAE) is a relatively uncommon angiographic finding with variable patterns of presentation. It is defined as localized coronary dilatation, which exceeds the diameter of normal adjacent segments or the diameter of the patient`s largest coronary vessel by 1.5 times.

we have evaluated the prevalence, characteristics and prognostic implications of this condition.

Patients and Methods:

From September 2010 to August 2012, 1004 patient were enlisted to coronary angiography registry at Kaplan medical center. based on patient records, relevant patient data, coronary anatomy and intervention, medical therapy at discharge, ectasia characteristics and follow up outcomes were examined.

Results:

CAE was found in 49 (4.88%) patients. The mean age was 69±11 years, 73.5% were males. RCA was the most commonly involved vessel (59%), followed by LCX (40%), LAD (20%) and LM (4%). Average ectasia to mean vessel diameter ratio was 1.86±0.39. The most common pattern was fusiform ectasia (59%) followed by saccular (31%) and diffuse pattern (22%).

ACS was the angiographic indication in 30 patients (61.2 %). PCI was subsequently performed in 25 (53.2%) of all cases. Patient where discharged with daul-antiplatelets for up to 12 months, 36 month or permanent, single antiplatelet and Coumadin (26, 5, 12 and 6 respectively). Ectasia was the sole indication for coumdin treatment in one case.

During a mean follow-up of 75.5±5 months, 15 (30.6%) patients had died, 5 patients (33%) due to cardiovascular cause. Twenty (40.8%) patients suffered repeated ACS presentations with revascularization. The cumulative Incidence of major adverse cardiovascular events (MACE) was 51% in 6 years. In 60% of subsequent angiographies, culprit lesion was related to the ectasia

Conclusions:

CAE has a higher rate of MACE compared with population without ectasia. This finding suggest that different interventional approach and further study are essential.