Is Anticoagulant Necessary in Patients with Coronary Artery Ectasia Presenting with Acute Coronary Syndrome? A Systematic Review of Case Reports

Abstract

Coronary artery ectasia is found in 3 to 8% of patient's undergoing angiography and may sometimes induce acute myocardial infarction. Some articles reported a recurrence of acute coronary syndrome (ACS) in the presence of coronary artery ectasia (CAE). Our study aims to summarize the latest evidence on whether the use of anticoagulant in addition to SAPT/DAPT (single antiplatelet/dual antiplatelet) treating ACS with CAE patients is necessary. Since the trials concerning our objectives were scarce, we pooled case reports/series. We performed a comprehensive search on case reports/series on coronary artery ectasia that presented with acute coronary syndrome published until March 2019. We collected 13 cases from 11 reports. Out of 13 patients, 5 (38.5%) took DAPT only without anticoagulant and 8 (61.5%) took anticoagulant ± DAPT. Three out of five (60%) who took DAPT only, experienced recurrences at 1st and 2nd months' follow-up. The other two (40%) was uneventful at a mean of two months' follow-up. Eight patients who took anticoagulant were uneventful for a mean of 8.4 months. Those who took anticoagulant were at lower risk of experiencing ACS recurrence (p = 0.035). Two of the patients who experienced recurrence became 6 and 12 months free after optimal anticoagulation. The author of this study proposed that anticoagulant must be considered should SAPT/DAPT failed to provide adequate protection to the recurrence of ACS, especially in CAE patients who did not have other obvious stenotic lesions. However, the evidence is weak since this study only pooled case reports/series.

Anti-inflammatory effects of rosuvastatin treatment on coronary artery ectasia patients of different age groups

“…Aksu T, Uygur B, Kosar, suggested that risk factors for CAD and the clinical presentation of CAE were considerably similar, and this situation was consistent with the similar etiopathogenesis of the two diseases [ 28 ]. Elevated inflammatory markers, such as plasma IL-6 and plasma soluble adhesion molecules, are closely linked to the presence of coronary artery dilation [ 29 – 31 ]. One study has indicated increasing evidence that neutrophils and neutrophil-derived products participate in atherogenesis and CAE [ 32 ].…”

Anti-inflammatory effects of rosuvastatin treatment in coronary artery ectasia patients in different age groups

“…However, the dilatation process may be independent of the atherosclerotic process because it can be found as an isolated lesion in coronary arteries and other vascular systems [21]. Elevated in ammatory markers, such as plasma IL-6 and plasma soluble adhesion molecules, are closely linked to the presence of coronary artery dilation [22][23][24]. Some studies have indicated increasing evidence that neutrophils and neutrophil-derived products participate in atherogenesis and CAE [25].…”

Antiagregantes y anticoagulantes en el manejo de ectasia coronaria con flujo lento, una revisión de reportes de caso

“…Y de los 8 pacientes del segundo escenario, ninguno presentó recurrencias de SCA durante el periodo de seguimiento. Así entonces, parece ser que TAPD + ACO es más efectiva que TAPD sola, especialmente en ectasia coronaria aislada, sin otras lesiones estenóticas (Pranata et al 2019).…”