Clinical Features And Outcome Of Prognosis Of Patients With Coronary Artery Ectasia

Background:Coronary artery ectasia?CAE?was first described in 1812.At first,coronary artery ectasia was frequently observed in patients with coronary atherosclerotic heart disease?CAD?,and because of its low incidence,it was considered a special type of coronary atherosclerotic heart disease and wasn't paid more attention.In recent years,with coronary CT angiography?CTA?,coronary angiography,and percutaneous coronary intervention popularized,clinicians have enabled to discover more cases of ectasia.With the increase of clinical cases,coronary atherosclerosis failed to fully explain the phenomenon of coronary artery ectasia.At the same time,there have some researches that have found that coronary artery ectasia is associated with poor prognosis in patients with coronary heart disease.Although coronary artery ectasia is frequently observed with the development of relevant examination techniques,the total number of clinical cases is still relatively minor,thus the related researches on coronary artery ectasia are greatly limitation.There are lack of a series of large samples of randomized controlled trial,the management on coronary artery ectasia has not formed a unified guidance.Objective:To investigate the clinical and angiographic characteristics of coronary artery ectasia?CAE?and analyze the prognosis of patients with coronary artery ectasia.Methods:This study was designed as a single-center retrospective study.Retrospective analysis 19620 patients from january 1^st,2010 to june 30^st,2018 in the our hospital,220patients confirmed with coronary artery ectasia bycoronary angiography,meanwhile,the same number of coronary heart disease patients without coronary artery ectasia were randomly selected as the control group,and the clinical data of the patients were obtained through the digital medical records system of our hospital.The main cardiovascular and cerebrovascular events adverse?MACCE?were recorded in our hospital and followed up by telephone,MACCE including all-cause death,cardiogenic death,non-fatal recurrent myocardial infarction,unplanned secondary revascularization,and new onset stroke.Results:Retrospective analysis of 19620 patients underging consecutive angiographic examinations,220 patients meeting CAE criteria for inclusion in the study group.The incidence of coronary artery ectasia in our hospital was 1.1%.1.Baseline data.CAE mean onset age 62.0±10.9 years old and CAD withput CAE group average age 62.5±9.0years old.The prevalence of males among CAE patients is higher than that of females,accounting for 82.2%.There was no significant difference in sex and age between the two groups.The clinical presentation describes as follows,acute ST-elevation myocardial infarction was found in 43 CAE patients and 35CAD without CAE patients?18.6%and 15.95%?,53 CAE patients and 50CAD without CAE patients presentd non-ST-elevation myocardial infarction;124 CAEand 135control without CAE presented Unstable Angina.In the risk factors of coronary heart disease,there was no significant difference between groups of routine risk factors such as hypertension history,diabetes history,smoking history.However,patients in CAE group were significantly higher than those in CAD without CAE group in terms of family history of coronary heart disease and lipid metabolic disorders?10.0%vs 2.7%,P=0.002;47.2%vs 34.1%,P=0.006?.Logistic regression analysis suggested that hypertension,family history of coronary heart disease and hyperlipidemia were positively correlated with coronary aneurysmal dilatation?family history of coronary heartdisease,OR:4.15,95%CI:1.52-11.3,P=0.005.hyperlipidemia,OR:1.7,95%CI:1.13-2.57,P=0.01;Hypertension,OR:1.52,95%CI:1.01-2.30,P=0.044?.2.Features of angiography.CAE involved one vessel in 193?87.73%?patients,whereas two coronaries were ectasic in 16?7.27%?patients,and all three coronaries were involved in 11?5%?of patients.A total of 258 coronary artery ectasia were involved,of which CAE was the most frequently involved in right coronary artery?RCA?,accounting for 40.38%,followed by left anterior descending artery?LAD?in 30.0%,left circumflex artery?LCX?in 23.08%and left main coronary artery?LM?in 6.54%.According to Markis classification,Markis IV is the most common,accounting for69.5%,followed by type III.87.3%of CAE patients were associated with obstruction coronary heart disease?O-CAD?.3.Comparison of the events during follow-up:199 patients in CAE group completed the follow-up,21 patients imcomplete follow-up,and 12 patients in the control group imcomplete follow-up.The follow-up time was 1-114 months,the average follow-up time was 45.8±22.4 months,and there was no statistical difference in the average follow-up time between CAE group and CAD group?51.3±25.95 VS 48.95±20.14,P=0.30?.The incidence of major MACCE in CAE group was higher than that in CAD group?26.1%vs 10.5%,P<0.001?.The MACCE of CAE and CAD without groups were compared as follows:non-fatal myocardial infarction?9.5%VS 4.32%,P=0.039?,unplanned target vascular reconstruction?10.05%VS 4.34%,P=0.02?,new onset stroke?3.01%VS 0,P=0.01?,and all-cause death?3.52%VS 1.44%,P=0.179?.4.Survival analysis.COX multivariate analysis was performed between the two groups:compared with CAD without CAE,coronary artery ectasia was an independent risk factor for MACCE events in patients with coronary artery disease?HR:1.91,95%CI:1.07-3.41,P=0.03?.Multi-vessel disease is a rik factor for the main endpoint events in patients with coronary heart disease?HR:2.28,95%CI:1.32-3.92,P=0.003?.Conclusions:1.Male predispose to CAE.The clinical features of patients with CAE are almost similar to those of patients with CAD without CAE,but CAE cannot be simple considered as a special variant type of CAD.2.CAE with family history of hypertension,coronary heart disease and hyperlipidemia predispose to coronary artery ectasia.3.Coronary artery ectasia increases the risk of adverse cardiovascular events in patients with coronary heart disease.Multi-vessel disease is a rik factor for the main endpoint events in patients with coronary heart disease.