Coronary Artery Ectasia; Prevalence and Clinical Characteristics: Experience From a Single Cardiac Center

Abstract

ABSTRACT… Background: Coronary artery ectasia (CAE) is well-recognized but relatively uncommon finding during diagnostic coronary angiography. Coronary artery ectasia is defined as a segment of coronary artery that is 1.5 times more dilated in diameter than the nearby segments. Its clinical presentations are unstable angina, coronary vasospasm, and acute myocardial infarction. Objectives: To determine the clinical characteristics, presentation and treatment in patients with documented coronary artery ectasia in a single Cardiac Centre at Faisalabad City Pakistan. Study Design: Retrospective descriptive study. Materials and Methods: This was a single center retrospective, descriptive study. Patients of either gender with age 21-70 years who had coronary angiography at Faisalabad Institute of Cardiology Faisalabad were included in the study. Coronary angiograms performed from April 2013 to December 2016 were reviewed. Patients fulfilling inclusion and exclusion criteria were enrolled. Clinical and angiographic profiles of the patients having coronary ectasia were retrieved from hospital record. Clinical profile included: age, gender and cardiovascular risk factors. Angiographic profile; prevalence of coronary ectasia, type of ectasia, associated obstructive disease and coronary vessel involved were noted. Results: Total 22235 patients under went coronary angiography from April 2013 to December 2016 at Faisalabad Institute of Cardiology Faisalabad. Out of 22235, 16913(76%) were male and 5322(24%) were female. Coronary artery ectasia (CAE) was observed in 1044(4.7%). Out of 1044, 931(89%) were male and 113(10.9%) were female patients. Mean age of study population was 49.5 ± 11.8 years. 368(31.97%) patients with CAE were in age group of 51-60 years followed by age group 41-50 years. 672 (64.36%) were hypertensive, 433 (41.7%) were diabetics, smoker were 574(54.98%). 442(42.33%) patients presented with ST elevation MI. 750 (71.84%) patient had mild Ectasia, 155 (34.87%) were suffering from severe coronary Ectasia. 364 (34.87%) patients had associated obstructive coronary artery disease. LAD was most commonly involved vessel in 392 (37.50%) followed by right coronary artery in 323 (30.94%). Type I ectasia was documented in 34.92%. Conclusions: In our study prevalence of CAE was 4.7%. CAE was more common in male, hypertensive, smokers and patients with Hyperlipedemia. Most common pattern of CAE was Type I and isolated ectasia without coronary artery obstruction. Left anterior descending artery was the most commonly involved vessel in ectasia followed by RCA. Key words:Ectasia, Angina, Infarction, Coronary artery.

Coronary Artery Ectasia in Patients with and Without Diabetes: A Study from Northern Pakistan

“…19 Recently, Ali et al reported that about 41.7% of patients diagnosed with CAE had diabetes. 20 Therefore, it was extremely important to study the spectrum of CAE in the diabetic population of our local population diagnosed with CAE on angiography. As per our study findings, no statistically significant difference (p-value<0.05) was shown with respect to the severity of disease in diabetic and non-diabetic patients.…”

Antiagregantes y anticoagulantes en el manejo de ectasia coronaria con flujo lento, una revisión de reportes de caso

“…La patogenia no ha sido del todo dilucidada, pero por el momento, se apunta al accionar del óxido nítrico (NO) de manera crónica, en el endotelio coronario (Alkhouli y Nunez Gil 2019), como lo demostró un estudio estadounidense realizado en veteranos de guerra en Vietnam, con ectasia coronaria, que estuvieron expuestos al 'agente naranja' (herbicida utilizado como arma química) (Dwyer y Flesch-Janys 1995), en el que se sugiere que la exposición prolongada estimula la producción de acetilcolina, que a su vez causa sobreestimulación de NO y adelgazamiento de la íntima media coronaria (Malviya et al 2017). Las manifestaciones clínicas son variables, suele cursar con angina estable, y en peculiares ocasiones con angina inestable, especialmente por reflujo retrógrado y lento de la arteria ectásica u oclusión parcial del segmento ectásico por la dinámica trombogénica del flujo (Ali et al 2017), factor implicado en el infarto de miocardio sin elevación del ST, y en ocasiones, del infarto con ST elevado, por lo que no es raro el síndrome coronario agudo (SCA) en estos pacientes (Papadakis et al 2001).…”