Outcome of Primary Percutaneous Intervention in Patients With Infarct-Related Coronary Artery Ectasia

Abstract

Data related to the incidence and clinical outcome of acute myocardial infarction (AMI) in patients with preexisting coronary artery ectasia (CAE) are limited. We assessed whether infarct-related artery ectasia (EIRA) indicates an untoward clinical outcome in patients with AMI undergoing primary percutaneous coronary intervention (pPCI). Consecutive patients (n = 643) who presented with AMI and were treated with pPCI were analyzed retrospectively; 31 patients (4.8%) had EIRA. Patients who had EIRA were significantly younger and had higher incidence of hypertension, previous stroke, smoking, inferior wall AMI, and Killip score >1. Infarct-related artery ectasia was more frequent in the right coronary artery (RCA). Impaired epicardial arterial flow, thrombus burden score of infarct-related artery (IRA), impaired Thrombolysis in Myocardial Infarction (TIMI) Myocardial Perfusion Grade, and distal embolization were significantly higher whereas ST-segment resolution and collateral vascular development were significantly lower in patients with EIRA. Infarct-related artery ectasia was an independent predictor of adverse outcome (odds ratio: 0.197; 95% confidence interval [CI]: 0.062-0.633; P = .006).

Coronary Artery Ectasia in Atherosclerotic Coronary Artery Disease, Inflammatory Disorders, and Sickle Cell Disease

“…The frequent coexistence of CAE with ACAD and the similarity in their prognosis made many authors believe that the CAE is merely a morphological variant of ACAD [1,2]. Different ACAD risk factors, such as male gender, hypertension, dyslipidemia, history of stokes and cigarette smoking, were reported to be risk factors for CAE [1,2,4,22]. However, despite the known strong association between atherosclerosis and diabetes mellitus (DM), an inverse association has been reported between CAE and DM [8,23].…”

“…Systemic anticoagulation therapy for primary prevention may not be warranted; however, it may be indicated for highrisk patients with severe coronary artery dilation (≥2-fold or ≥8 mm), which has been found to be associated with higher morbidity and mortality rates [9,66,67]. The presence of hypertension, dyslipidemia, or smoking in patients with atherosclerotic CAE places them at a higher risk for developing more severe CAE [1,2,4,22]. Therefore, aggressive control of such risk factors remains important in those patients and possibly even in all types of CAE in general.…”

Coronary artery ectasia as a culprit for acute myocardial infarction: review of pathophysiology and management

“…Thrombus burden TIMI frame count measurement has been found to be significantly higher in CAE and well correlated with ectatic segment size and ratio (38)(39)(40). This suggested a clear predisposition to higher thrombus burden in the ectatic segments and adverse outcome.…”

“…Dual antiplatelet therapy (DAPT) should also be instituted if PCI is performed. Observations from Erden et al (39) and others pointed out at that the combination of triple anticoagulant therapy especially in acute setting of CAE withthrombus burden-related MI. While oral anticoagulant still to be considered even in non-ectasia related infarction as there is a potential to further thrombus formation in ectatic segments, as high as 32% (43).…”

“…This suggested a clear predisposition to higher thrombus burden in the ectatic segments and adverse outcome. Erden et al (39) found impaired epicardial arterial flow, thrombus burden score of infarct-related artery (IRA), impaired TIMI Myocardial Perfusion Grade, and distal embolization significantly higher and ST-segment resolution and collateral vascular development significantly lower in infarct related CAE. Prior to these findings, Yip et al (40) had also found that ectasia related infarct is associated with high-burden thrombus formation and has a significantly lower incidence of successful reperfusion (38).…”