Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients.

Abstract

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.

Clinical and Angiographic Features of Patients with Coronary Artery Ectasia Compared with Stenotic Coronary Artery Disease

“…Of the four age segments, CAE was more common in the younger age group, while stenotic CAD was common in older age. This is in agreement with previous studies [10][11][12][13]. Giannoglu et al [11] also reported more male patients having CAE.…”

“…Giannoglu et al [11] also reported more male patients having CAE. This gender difference has been reported previously [12,13] and is supposed to be due to a lower incidence of CAD in women [11]. Considering the different age segments, we found nearly three quarters of CAE to be younger than 60 years .…”

“…Patients with CAE without stenosis had significantly more frequent abnormal treadmill stress tests compared with those with normal coronary angiography, suggesting decrease in coronary flow reserve and microvascular dysfunction as a possible contributing factor for myocardial ischemia in CAE. Hartnell [12] and Markis [23] reported that angina is the most common presenting complaint in patients with CAE. However in our study ACS is the most common presentation in patients with CAE.…”

A Rare Occurrence of Congenital Coronary Ectasia Combined with Ventricular Septal Defect

“…It is characterized by an abnormal dilatation of coronary artery, represents a form of atherosclerotic coronary artery disease, seen in 3-8% of patients undergoing coronary angiography [1]. Abnormal dilatation of a vessel could be long segmental involvement of partial aneurysm formation.…”

“…Coronary artery ectasia (CAE) is a well-recognized but relatively uncommon finding encountered during diagnostic coronary angiography in adult [1]. In infant, coronary dilatation is mostly due to coronary complications of Kawasaki disease (KD).…”