SUMMARY To assess the clinical significance of coronary artery ectasia 4993 consecutive coronary arteriograms were reviewed to identify patients with this condition and to allow the assessment of their progress. Coronary ectasia was a relatively uncommon finding (overall incidence 1-4%). It was not related to the development of aortic aneurysms and did not affect the outcome, results of coronary artery surgery, or symptoms.Coronary artery ectasia has been a well recognised, if uncommon, pathological finding for many years.'The advent of cardiac catheterisation allowed the diagnosis to be made in life, and associations have been reported with trauma,2 polyarteritis nodosa,3 Takayasu's disease,4 mucocutaneous lymph node syndrome,5 congenital abnormalities,6 and syphilis. In westem populations the most common association is with atherosclerotic coronary artery disease. Estimates of the incidence of coronary ectasia have varied from 0 3%7 to 4-7%.8 As definitions of ectasia in the various published series are similar these differences may reflect differences between the populations studied, observer bias, or random variation in the smaller series. Most published series suggest that the incidence in patients investigated for ischaemic heart disease is between 1% and 2-5%(1.2% 910 1*3%," 1-5%, 12 2.2%/ 13 and 2-5%14).The clinical significance of coronary ectasia is not clear. It has been suggested that the presence of ectasia alone is as important as the presence of coronary artery stenosis.9 Another study showed no difference from a control population with ischaemic heart disease.8 An association with aortic aneurysm has also been reported,"5 although most series do not mention any relation between the two. It has been said that the presence of ectasia does not affect the outcome of coronary bypass grafting unless the graft is sutured into the wall of the ectatic segment.'3We reviewed a large series of patients undergoingRequests for reprints to Dr G G Hartnell, Department of Radiology, Hammersmith Hospital, Du Cane Road, London W12 OHS.Accepted for publication 2 July 1985 coronary angiography to determine the incidence of coronary ectasia. In addition, we tried to assess its clinical significance, especially in terms of mortality and effect on coronary artery surgery. Patients and methodsOver the period 1976-82 all coronary angiograms at this hospital were reported by the same two radiologists (usually together but sometimes singly). Coronary artery ectasia was diagnosed when a segment of artery was more than 1-5 times the diameter of adjacent normal segments of artery (Figs. a and b). The case notes of those patients who were diagnosed as having ectasia were reviewed to assess the distribution of ectasia and associated stenosis and obtain details of subsequent cardiac surgery, aortic aneurysm, death, or other cardiac events. Where patients had been followed elsewhere details were requested from the patient's general practitioner. Full follow up data were available on 47 of the 70 patients with ectasia.

This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health.

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With the advent of successful revascularization of blocked and narrowed coronary arteries, using venous bypass grafts from the aorta, the demand for coronary angiography has risen rapidly during the past 5 years. At Harefield 25 arteriograms were performed in 1970 but 615 in 1975 (Fig. 1) though circumstances beyond our control reduced the number conspicuously at the end of the last year. Information about the safety of this examination is, therefore, important. Emanuel (1975) circularized 50 British centres undertaking coronary angiography in 1973. Of the 46 who replied, only 9 knew the mortality rate for their institution; the highest was up to 0-6 per cent. The morbidity ranged from 0 9 to 2-2 per cent. In 1973, Petch, Sutton, and Jefferson reported a series of 400 angiograms with an overall mortality of 1P5 per cent; 2-4 per cent for the 248 done by Judkins' (1967) method and a zero mortality for the 111 by Sones and Shirey's (1962) method. Adams, Fraser, and Abrams (1973), in a nationwide survey of the United States, found a 0-8 per cent mortality for Judkins' technique and a 0 13 per cent mortality for Sones'.The purpose of this paper is to review our experience with particular reference to complications.