Effect of type 2 diabetes on coronary artery ectasia: smaller lesion diameter and shorter lesion length but similar adverse cardiovascular events

Abstract

Background Coronary artery ectasia (CAE) is a rare finding in coronary angiography and associated with poor clinical outcomes. Unlike atherosclerosis, diabetes mellitus (DM) is not commonly associated with CAE. This study aims to investigate the effect of type 2 diabetes mellitus (DM2) on coronary artery ectasia, especially the differences in angiographic characteristics and clinical outcomes. Methods Patients with angiographically confirmed CAE from 2009 to 2015 were included. Quantitative coronary angiography (QCA) was performed to measure the diameter and length of the dilated lesion. The primary endpoint was the maximum diameter and maximum length of the dilated lesion at baseline coronary angiography. The secondary endpoint was 5-year major adverse cardiovascular events (MACE), which was a component of cardiovascular death and nonfatal myocardial infarction (MI). Propensity score weighting (PSW) and propensity score matching (PSM) were used to balance covariates. Kaplan–Meier method and Cox regression were performed to assess the clinical outcomes. Results A total of 1128 patients were included and 258 were combined with DM2. In the DM2 group, the maximum diameter of dilated lesion was significantly lower (5.26 mm vs. 5.47 mm, P = 0.004) and the maximum length of the dilated lesion was significantly shorter (25.20 mm vs. 31.34 mm, P = 0.002). This reduction in dilated lesion diameter (5.26 mm vs. 5.41 mm, P = 0.050 in PSW; 5.26 mm vs. 5.46 mm, P = 0.007 in PSM, respectively) and length (25.17 mm vs. 30.17 mm, P = 0.010 in PSW; 25.20 mm vs. 30.81 mm, P = 0.012 in PSM, respectively) was consistently observed in the propensity score analysis. A total of 27 cardiovascular deaths and 41 myocardial infarctions occurred at 5-year follow-up. Compared with non-DM group, there were similar risks of MACE (6.02% vs. 6.27%; HR 0.96, 95% CI 0.54–1.71, P = 0.894), cardiovascular death (2.05% vs. 2.61%; HR 0.78, 95% CI 0.29–2.05, P = 0.605) and MI (4.07% vs. 3.72%; HR 1.11, 95% CI 0.54–2.26, P = 0.782) in patients with DM2. Consistent result was observed in multivariable regression. Conclusions Compared to non-DM patients, patients with CAE and type 2 diabetes were associated with a smaller diameter and shorter length of dilated vessels, suggesting the important effect of DM2 on the pathophysiological process of CAE. Similar risks of MACE were found during 5-year follow up among diabetic and non-DM patients.

The Impact of C-Peptide and Diabetes Mellitus on Coronary Ectasia and Effect of Coronary Ectasia and C-Peptide on Long-Term Outcomes: A Retrospective Cohort Study

“…In a metaanalysis, low C-peptide levels were associated with cardiovascular mortality and the development of cerebrovascular events in diabetic patients48, while in other studies, high C-peptide levels were associated with poor long-term clinical outcomes [10,47,48]. In addition, CAE was associated with increased cardiovascular mortality [3,5]. In our study, C-peptide is independently associated with precense of CAE and C-peptide levels were positively correlated with the severity of CAE also there was a negative association between diabetes mellitus and the presence of CAE.…”

“…Among these factors, atherosclerosis is accepted as the main reason for the formation of ectasia [3]. Although it is often associated with atherosclerosis and is considered a variant of atherosclerosis, its poorer clinical outcomes than atherosclerotic CAD and the fact that it can be seen as isolated CAE without atherosclerosis suggest that determinants different from atherosclerosis may play a role in the development of CAE [4,5]. Although patients with diabetes mellitus (DM) are a major risk factor for CAD, it is seen less frequently in these patients [6].…”

Association of remnant cholesterol with Coronary Artery Ectasia: A Cross-Sectional Study

“…Coronary artery ectasia (CAE), also known as coronary artery aneurysm (CAA), is characterized by the abnormal dilation or widening of one or more coronary arteries, where the affected artery's diameter exceeds 1.5 times that of the adjacent normal segment [1,2]. The majority of CAE cases exhibit no clinical symptoms and are often discovered incidentally during coronary angiography or computed tomography, with estimated incidence rates ranging from 0.3-5% [3,4]. Men are more commonly affected than women, and the condition tends to be prevalent in the proximal segments of the coronary bed compared to the distal ones [5].…”