Slow Flow Phenomenon Impairs the Prognosis of Coronary Artery Ectasia as Well as Coronary Atherosclerosis

Kaplan, Mehmet; Abacıoğlu, Özge Özcan; Yavuz, Fethi; Kaplan, Gizem; Topuz, Mustafa

doi:10.21470/1678-9741-2020-0618

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…The term coronary artery ectasia (CAE) refers to abnormal coronary artery dilatations exceeding >1.5 times the diameter of the normal adjacent segment. 1 Although CAE has been long considered a benign variant of the coronary artery tree, 2 a large body of evidence linked the presence of CAE with the occurrence of myocardial ischemia by means of complex pathogenic mechanisms, such as slow coronary flow, 3,4 coronary microvascular dysfunction, 5 vasospasm 6 and increased susceptibility to thrombosis in the dilated segment and distal embolization 7 and clinical manifestations vary greatly. [8][9][10][11][12][13][14][15] A relevant proportion of ectatic lesions occur in patients with nonobstructive coronary artery disease (NOCAD) 16 and previous observational reports outlined an excess of adverse events in this population as compared with a matched control group.…”

Section: Introductionmentioning

confidence: 99%

Prognostic role of coronary artery ectasia in patients with nonobstructive coronary artery disease

Gurgoglione,

Benatti,

Vignali

et al. 2024

Journal of Cardiovascular Medicine

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Aims Coronary artery ectasia (CAE) has been linked to the occurrence of adverse events in patients with ischemia/angina and no obstructive coronary arteries (INOCA/ANOCA), while the relationship between CAE and myocardial infarction with nonobstructive coronary arteries (MINOCA) has been poorly investigated. In our study we aimed at assessing differences in clinical, angiographic and prognostic features among patients with CAE and MINOCA vs. INOCA/ANOCA presentation. Methods Patients with angiographic evidence of CAE were enrolled at the University Hospital of Parma and divided into MINOCA vs. INOCA/ANOCA presentation. Clinical and quantitative angiographic information was recorded and the incidence of major adverse cardiovascular events (MACE) was assessed at follow-up. Results We enrolled a total of 97 patients: 49 (50.5%) with MINOCA and 48 (49.5%) with INOCA/ANOCA presentation. The presentation with MINOCA was associated with a higher frequency of inflammatory diseases (P = 0.041), multivessel CAE (P = 0.030) and thrombolysis in myocardial infarction (TIMI) flow < 3 (P = 0.013). At a median follow-up of 38 months, patients with MINOCA had a significantly higher incidence of MACE compared with those with INOCA/ANOCA [8 (16.3%) vs. 2 (4.2%), P = 0.045], mainly driven by a higher rate of nonfatal MI [5 (10.2%) vs. 0 (0.0%), P = 0.023]. At multivariate Cox regression analysis, the presentation with MINOCA (P = 0.039) and the presence of TIMI flow <3 (P = 0.037) were independent predictors of MACE at follow-up. Conclusion Among a cohort of patients with CAE and nonobstructive coronary artery disease, the presentation with MINOCA predicted a worse outcome.

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Section: Introductionmentioning

confidence: 99%

Prognostic role of coronary artery ectasia in patients with nonobstructive coronary artery disease

Gurgoglione,

Benatti,

Vignali

et al. 2024

Journal of Cardiovascular Medicine

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show abstract

“…Its pathological manifestations are characterized by the extensive destruction of musculoelastic elements, particularly elastin fibers, which are dominant components of the extracellular matrix of the coronary wall ( 4 , 5 ). It leads to slow blood flow and dysfunction in microcirculation ( 6 , 7 ), thrombosis in the expanded coronary ( 3 ), and increased rupture risk of the expanded part ( 8 ). Therefore, the main clinical manifestations include angina, acute myocardial infarction (AMI), arrhythmia, and sudden death ( 2 , 9 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

Five-years’ prognostic analysis for coronary artery ectasia patients with coronary atherosclerosis: A retrospective cohort study

Liu

Gao

Liang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundMost of coronary artery ectasia (CAE) patients have comorbid coronary atherosclerosis. It was lack of prognostic data for CAE patients with coronary heart disease (CHD) and for whom with acute myocardial infarction (AMI).ObjectiveTo determine the overall prognosis for CAE patients.Materials and methodsThis study was a retrospective cohort study. Fifty-one patients with CAE and comorbid AMI (CAE + AMI) and 108 patients with CAE and comorbid CHD (CAE + CHD) were enrolled and matched to non-CAE subjects at a ratio of 1:3 using a propensity score method, respectively. Controls for CAE + AMI group were 153 AMI patients, controls for CAE group were 324 CHD patients and 329 participants with relatively normal coronary arteries (CON). We followed them up to observe major cardiovascular events (MACE).ResultsThe Kaplan-Meier curves showed that the prognosis in CAE + AMI group was worse than in AMI group (5-year non-MACE rate: 62.70% vs. 79.70%, P = 0.010), the prognosis in CAE group was worse than in CHD and CON groups (5-year non-MACE rate: 74.10% vs. 85.80% and 96.70%, respectively, P = 0.000). The main MACEs in CAE + AMI and CAE groups were AMI reoccurrence (19.61% vs. 4.57%, P = 0.002) and re-hospitalization due to repeated angina pectoris (14.81% vs. 8.33% and 2.74%, P = 0.000), respectively. Additionally, the COX regression analysis revealed that the protective factors for preventing MACE in CAE + AMI group included antiplatelet agents (hazard ratio = 0.234, P = 0.016) and angiotensin-converting enzyme inhibitor/angiotensin receptor inhibitor (ACEI/ARB, hazard ratio = 0.317, P = 0.037). Whereas the main factor promoting MACE in CAE group was the degree of coronary stenosis (Gensini score, hazard ratio = 1.011, P = 0.022).ConclusionThe prognosis of patients with CAE + AMI was worse than that of those with AMI. The overall prognosis of patients with CAE was worse than that of those with CHD. CAE + AMI and CAE groups had different characteristics; the former was prone to AMI reoccurrence, and the latter was prone to repeated angina pectoris. To prevent MACE, medications, including antiplatelets and ACEI/ARBs, are indicated for patients with CAE + AMI, whereas prevention of the progression of atherosclerotic lesions is indicated for patients with CAE.

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Analysis of Risk Factors and Construction of a Predictive Model for Readmission in Patients with Coronary Slow Flow Phenomenon

Yan,

Guo,

Cao

2024

IJGM

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Slow Flow Phenomenon Impairs the Prognosis of Coronary Artery Ectasia as Well as Coronary Atherosclerosis

Cited by 3 publications

References 23 publications

Prognostic role of coronary artery ectasia in patients with nonobstructive coronary artery disease

Prognostic role of coronary artery ectasia in patients with nonobstructive coronary artery disease

Five-years’ prognostic analysis for coronary artery ectasia patients with coronary atherosclerosis: A retrospective cohort study

Analysis of Risk Factors and Construction of a Predictive Model for Readmission in Patients with Coronary Slow Flow Phenomenon

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