Clinical Characteristics,Survival Analysis And Serum Biomarkers Of Coronary Artery Ectasia

Objective:Coronary artery ectasia is a rare cardiovascular disease.Its pathogenesis mechanism remains unclear,and previous studies revealed close relation to atherosclerosis and inflammation.Its prevalence,clinical characteristics,and prognosis in the Chinese population has not been reported clearly.This study aimed to track a group of coronary artery ectasia patients through a registration system.Clinical manifestation,imaging characteristics and survival analysis were summarized and compared with coronary artery disease patients.Biomarkers and pathway involved in the pathogenesis of coronary artery ectasia were screened by protein arrays and ELISA test.Methods:This retrospective cohort study included adult patients diagnosed with coronary artery ectasia in the Department of Cardiology of Peking Union Medical College Hospital from 2009 to 2019.Baseline clinical history,laboratory test and treatment were obtained and uploaded the National Rare Disease Registration System(NRDRS).Coronary angiography images were collected and evaluated.Patients were followed up by telephone questionnaire.The primary outcome was cardiovascular death(myocardial infraction,heart failure,sudden cardiac death and stroke).The secondary outcome was a composite outcome of all-cause mortality,cardiovascular rehospitalization,coronary revascularization including percutaneous coronary intervention and coronary artery bypass surgery.Meanwhile,protein arrays of inflammation and atherosclerosis factors were carried out using patient serum samples stored in the biological sample bank of Peking Union Medical College Hospital.Bioinformatics analysis was applied to explore possible molecules and pathways involved in the pathogenesis of coronary artery ectasia,and several potential molecules were confirmed by ELISA test.Results:This study found that the estimated prevalence of coronary artery ectasia in patients who underwent coronary angiography is 1.5%.Compared with patients with coronary heart disease,hsCRP level in coronary ectasia group was significantly increased,and the proportion of patients receiving PCI was lower.There is no difference between laboratory tests and medical treatment.Coronary angiography revealed the main branch of coronary artery was the right coronary artery,and the highest proportion was Markis type ?.Follow-up data showed no significant difference in the survival of coronary artery ectasia and coronary heart disease during a follow-up period of 5 years,but the proportion of recurrent angina pectoris was higher in coronary artery ectasia group.Protein arrays and bioinformatic analysis suggest that angiostatin,adiponectin and LOX-1 may be involved in the pathogenesis of coronary artery ectasia,while serum MMP8 is a potential prognostic indicator.GO/KEGG pathway analysis revealed the potential function of cytokine-cytokine receptor binding pathway.Conclusion:The epidemiological characteristics,clinical manifestations and imaging features of coronary artery ectasia summarized in this cohort study were consistent with previous literature.The 5-year survival curve showed no difference between the prognosis of coronary artery ectasia and coronary heart disease,but coronary artery ectasia patients presented with a significant intensive inflammatory state.Protein pathways including lipid metabolism disorders and inflammatory factors may be involved in the pathogenesis of coronary artery ectasia.