Risk factors and cardiovascular outcomes in patients with coronary artery ectasia presented with st elevation myocardial infarction
Authors: Dattoli-Garcia C , Gonzalez-Gutierrez JC , Jackson-Pedroza C , Gallardo-Grajeda A , Gopar-Nieto R , Pina-Fragoso V , Alfaro-Ponce D , Ruiz-Fuentes O , Araiza-Garaygordobil D , Arias-Mendoza A 
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

PHASE-MX

Background

Coronary artery ectasia (CAE), defined as "a dilatation greater than 1.5 times the diameter of the adjacent normal coronary arteries", is an uncommon finding in patients with acute coronary syndrome with a reported prevalence from 0.3 to 4.9% in different series. Because its low frequency, at present time there is lack of evidence and consensus of treatment strategies in those patients. 

Purpose

To identify differences in risk factors, treatment strategies and cardiovascular outcomes among population with and without CAE presented with STEMI. 

Methods

A retrospective, observational, comparative study was conducted in a tertiary-level cardiovascular center. We included hospitalized patients between 2018 and 2020 diagnosed with STEMI who had received reperfusion treatment within 12 hours of symptom onset. Coronary angiography was performed in the setting of primary PCI or pharmacoinvasive strategy. The primary composite endpoint was the time to first occurrence of either cardiovascular death, cardiogenic shock, recurrent MI or congestive heart failure at 30 days of follow-up according to the presence or absence of coronary artery ectasia.

Results

We identified 539 patients with a STEMI diagnosis, of those 56 (10.3%) were diagnosed with CAE and 483 without CAE (89.7%). The median age of population was 57.9 (±10.9 SD) with no differences between groups and most of them were male (94.6% vs 85.7%, p 0.08). Among risk factors we identified a lower prevalence of type 2 diabetes mellitus in patients with CAE (14.2% vs 36.4%, p 0.001), no difference was observed in prevalence of hypertension (44.6% vs. 43.4%, p 0.86), obesity (26.7% vs 23.4%, p 0.57), dyslipidemia (26.7% vs 18.8%, p 0.35) or smoking (35.7% vs 45.1%, p 0.17). 

In angiographic findings of patients diagnosed with CAE the infarction culprit artery had ectasia in 83.9% (n = 47) of the patients. According to the Markis classification, type 1 was the most common type, with the right coronary artery presenting the greatest involvement (72.7%, n= 40), followed by the anterior descending artery (67.2%, n= 37) and finally by circumflex artery (54.5%, n= 30).

There were no differences in reperfusion strategies performed between both groups, pharmacoinvasive strategy (43.6% vs 50.6%, p 0.32) or PCI (56.4% VS 49.4%, P 0.12).  There was no difference in the primary composite endpoint of MACE over a period of 30 days of follow up (8.93% vs 10.3%, p 0.73) Figure 1. There was also no difference in major or minor bleeding between groups (5.4% vs 3.6%, p 0.78; and 3.5% vs 1.6%, p 0.37).

Conclusion

CAE is a disease with a higher prevalence in México than reported in other countries. There are no identifiable risk factors in our study that predicts the presence of CAE in patients diagnosed with STEMI.  Both reperfusion strategies used (Pharmacoinvasive strategy and primary PCI) could be safe with no differences in cardiovascular outcomes or bleeding at 1 month of follow-up. Abstract Figure.