Diffuse coronary artery dilation predicted worse long-term outcomes in patients with coronary artery Ectasia

Cai, Zhongxing; Liu, Jianxin; Wang, Haoyu; Yin, Dong; Song, Weihua; Dou, Kefei

doi:10.1016/j.ijcard.2020.05.054

Cited by 18 publications

(20 citation statements)

References 15 publications

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“…The summary of primary outcomes is shown in Table 3 , with secondary outcomes in Table 4 . Additionally, diffuse dilation, which we found to be a prognostic factor previously ( 6 ), was also associated with a higher risk of MACE in both univariable (HR 2.13, 95% CI 1.21–3.75, P = 0.009) and multivariable Cox regression (HR 4.12, 95% CI 1.96–8.63, P < 0.001) in the current study. The C-statistic estimation of diffuse dilation for predicting 5-year MACE was 0.59 (95% CI 0.53 to 0.66, p = 0.009) ( Supplementary Figure 2B ).…”

Section: Resultssupporting

confidence: 78%

“…Previously, we found that diffuse dilation predicted poor long-term outcomes in 595 patients with CAE ( 6 ). The present study reconfirmed the association between diffuse dilation and adverse cardiovascular events in this larger population.…”

Section: Discussionmentioning

confidence: 87%

“…This rare phenomenon is associated with poor clinical outcomes and increased risk of death, non-fatal myocardial infarction (MI), and major adverse cardiovascular events have been observed ( 4 , 5 ). Previously, our cohort study indicated that diffuse CAE was associated with worse long-term outcomes, compared with focal CAE, which is also known as coronary artery aneurysms (CAA)( 6 ). However, the risk predictors of coronary artery ectasia are not well studied and current studies are limited because of their relatively small sample size.…”

Section: Introductionmentioning

confidence: 99%

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Plasma Big Endothelin-1 Level Predicted 5-Year Major Adverse Cardiovascular Events in Patients With Coronary Artery Ectasia

Cai

Wang

Yuan

et al. 2021

Front. Cardiovasc. Med.

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Background: Coronary artery ectasia (CAE) is found in about 1% of coronary angiography and is associated with poor clinical outcomes. The prognostic value of plasma big Endothelin-1 (ET-1) in CAE remains unknown.Methods: Patients with angiographically confirmed CAE from 2009 to 2015, who had big ET-1 data available were included. The primary outcome was 5-year major adverse cardiovascular events (MACE), defined as a component of cardiovascular death and non-fatal myocardial infarction (MI). Patients were divided into high or low big ET-1 groups using a cut-off value of 0.58 pmol/L, according to the receiver operating characteristic curve. Kaplan-Meier method, propensity score method, and Cox regression were used to assess the clinical outcomes in the 2 groups.Results: A total of 992 patients were included, with 260 in the high big ET-1 group and 732 in the low big ET-1 group. At 5-year follow-up, 57 MACEs were observed. Kaplan-Meier analysis and univariable Cox regression showed that patients with high big ET-1 levels were at increased risk of MACE (9.87 vs. 4.50%; HR 2.23, 95% CI 1.32–3.78, P = 0.003), cardiovascular death (4.01 vs. 1.69%; HR 2.37, 95% CI 1.02–5.48, P = 0.044), and non-fatal MI (6.09 vs. 2.84%; HR 2.17, 95% CI 1.11–4.24, P = 0.023). A higher risk of MACE in the high big ET-1 group was consistent in the propensity score matched cohort and propensity score weighted analysis. In multivariable analysis, a high plasma big ET-1 level was still an independent predictor of MACE (HR 1.82, 95% CI 1.02–3.25, P = 0.043). A combination of high plasma big ET-1 concentrate and diffuse dilation, when used to predict 5-year MACE risk, yielded a C-statistic of 0.67 (95% CI 0.59–0.74).Conclusion: Among patients with CAE, high plasma big ET-1 level was associated with increased risk of MACE, a finding that could improve risk stratification.

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Section: Resultssupporting

confidence: 78%

Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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Plasma Big Endothelin-1 Level Predicted 5-Year Major Adverse Cardiovascular Events in Patients With Coronary Artery Ectasia

Cai

Wang

Yuan

et al. 2021

Front. Cardiovasc. Med.

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“…Moreover, patients with Thrombolysis In Myocardial Infarction (TIMI) flow <3 showed a higher occurrence of ACS at follow up compared to patients with normal epicardial flow, with further adverse impact on outcomes when associated with multivessel CAE (9). A cohort study on 595 Chinese patients with CAE, compared the clinical outcome of the two anatomical phenotypes of CAE, diffuse CAE, or ectasia, and focal CAE, or CAAs: patients with diffuse CAE, compared to the group with focal coronary dilations, showed a significantly higher incidence of major cardiovascular events, defined as cardiovascular death and non-fatal MI, at both propensity-matched and propensityweighted analyses (75). These findings might indicate that a diffuse extension of CAE in the coronary tree results in a greater impairment of coronary flow and a higher risk of thrombotic and embolic events, thus affecting long-term clinical outcome of these patients.…”

Section: Natural History and Prognostic Stratificationmentioning

confidence: 99%

Treatment and Outcome of Patients With Coronary Artery Ectasia: Current Evidence and Novel Opportunities for an Old Dilemma

Esposito

Maio

Silverio

et al. 2022

Front. Cardiovasc. Med.

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Coronary artery ectasia (CAE) is defined as a diffuse or focal dilation of an epicardial coronary artery, which diameter exceeds by at least 1. 5 times the normal adjacent segment. The term ectasia refers to a diffuse dilation, involving more than 50% of the length of the vessel, while the term aneurysm defines a focal vessel dilation. CAE is a relatively uncommon angiographic finding and its prevalence ranges between 0.3 and 5% of patients undergoing coronary angiography. Although its pathophysiology is still unclear, atherosclerosis seems to be the underlying mechanism in most cases. The prognostic role of CAE is also controversial, but previous studies reported a high risk of cardiovascular events and mortality in these patients after percutaneous coronary intervention. Despite the availability of different options for the interventional management of patients with CAE, including covered stent implantation and stent-assisted coil embolization, there is no one standard approach, as therapy is tailored to the individual patient. The abnormal coronary dilation, often associated with high thrombus burden in the setting of acute coronary syndromes, makes the interventional treatment of CAE patients challenging and often complicated by distal thrombus embolization and stent malapposition. Moreover, the optimal antithrombotic therapy is debated and includes dual antiplatelet therapy, anticoagulation, or a combination of them. In this review we aimed to provide an overview of the pathophysiology, classification, clinical presentation, natural history, and management of patients with CAE, with a focus on the challenges for both clinical and interventional cardiologists in daily clinical practice.

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“…In terms of dilated lesions, patients with diabetes were more focal and relatively less severe. This might partly explain the fewer presence of acute MI in the non-DM group, as diffuse dilation was associated with MI in CAE [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

Effect of type 2 diabetes on coronary artery ectasia: smaller lesion diameter and shorter lesion length but similar adverse cardiovascular events

Cai

Wang

et al. 2022

Cardiovasc Diabetol

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Background Coronary artery ectasia (CAE) is a rare finding in coronary angiography and associated with poor clinical outcomes. Unlike atherosclerosis, diabetes mellitus (DM) is not commonly associated with CAE. This study aims to investigate the effect of type 2 diabetes mellitus (DM2) on coronary artery ectasia, especially the differences in angiographic characteristics and clinical outcomes. Methods Patients with angiographically confirmed CAE from 2009 to 2015 were included. Quantitative coronary angiography (QCA) was performed to measure the diameter and length of the dilated lesion. The primary endpoint was the maximum diameter and maximum length of the dilated lesion at baseline coronary angiography. The secondary endpoint was 5-year major adverse cardiovascular events (MACE), which was a component of cardiovascular death and nonfatal myocardial infarction (MI). Propensity score weighting (PSW) and propensity score matching (PSM) were used to balance covariates. Kaplan–Meier method and Cox regression were performed to assess the clinical outcomes. Results A total of 1128 patients were included and 258 were combined with DM2. In the DM2 group, the maximum diameter of dilated lesion was significantly lower (5.26 mm vs. 5.47 mm, P = 0.004) and the maximum length of the dilated lesion was significantly shorter (25.20 mm vs. 31.34 mm, P = 0.002). This reduction in dilated lesion diameter (5.26 mm vs. 5.41 mm, P = 0.050 in PSW; 5.26 mm vs. 5.46 mm, P = 0.007 in PSM, respectively) and length (25.17 mm vs. 30.17 mm, P = 0.010 in PSW; 25.20 mm vs. 30.81 mm, P = 0.012 in PSM, respectively) was consistently observed in the propensity score analysis. A total of 27 cardiovascular deaths and 41 myocardial infarctions occurred at 5-year follow-up. Compared with non-DM group, there were similar risks of MACE (6.02% vs. 6.27%; HR 0.96, 95% CI 0.54–1.71, P = 0.894), cardiovascular death (2.05% vs. 2.61%; HR 0.78, 95% CI 0.29–2.05, P = 0.605) and MI (4.07% vs. 3.72%; HR 1.11, 95% CI 0.54–2.26, P = 0.782) in patients with DM2. Consistent result was observed in multivariable regression. Conclusions Compared to non-DM patients, patients with CAE and type 2 diabetes were associated with a smaller diameter and shorter length of dilated vessels, suggesting the important effect of DM2 on the pathophysiological process of CAE. Similar risks of MACE were found during 5-year follow up among diabetic and non-DM patients.

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Diffuse coronary artery dilation predicted worse long-term outcomes in patients with coronary artery Ectasia

Cited by 18 publications

References 15 publications

Plasma Big Endothelin-1 Level Predicted 5-Year Major Adverse Cardiovascular Events in Patients With Coronary Artery Ectasia

Plasma Big Endothelin-1 Level Predicted 5-Year Major Adverse Cardiovascular Events in Patients With Coronary Artery Ectasia

Treatment and Outcome of Patients With Coronary Artery Ectasia: Current Evidence and Novel Opportunities for an Old Dilemma

Effect of type 2 diabetes on coronary artery ectasia: smaller lesion diameter and shorter lesion length but similar adverse cardiovascular events

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