Post-PCI outcomes in STEMI patients with coronary ectasia: meta-analysis

Mir, Tanveer; Sattar, Yasar; Uddin, Mohammed; Changal, Khalid; Kumar, Kartik; Attique, Hassan Bin; Kabashneh, Sohaip; Ullah, Waqas; Lohia, Prateek; Alraies, M. Chadi; Blank, Nimrod; Afonso, Luís; Qureshi, Waqas

doi:10.1080/14779072.2021.1889370

Cited by 10 publications

(5 citation statements)

References 21 publications

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“…Bogana Shanmugam et al compared 25 STEMI patients with an EIRA to a cohort of 80 non-EIRA STEMI patients and found that the EIRA group, despite similar in-hospital outcomes, had a higher incidence of long-term cardiovascular events, particularly driven by recurrent MI, unstable angina (UA), and need for surgical revascularization (70). Conversely, in a recent metanalysis of 6 observational studies on patients with STEMI treated with primary PCI, no difference in terms of mortality were reported between CAE and non-CAE patients, despite a higher thrombus burden and a lower post-procedural TIMI flow in the CAE group (71).…”

Section: Natural History and Prognostic Stratificationmentioning

confidence: 99%

Treatment and Outcome of Patients With Coronary Artery Ectasia: Current Evidence and Novel Opportunities for an Old Dilemma

Esposito

Maio

Silverio

et al. 2022

Front. Cardiovasc. Med.

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Coronary artery ectasia (CAE) is defined as a diffuse or focal dilation of an epicardial coronary artery, which diameter exceeds by at least 1. 5 times the normal adjacent segment. The term ectasia refers to a diffuse dilation, involving more than 50% of the length of the vessel, while the term aneurysm defines a focal vessel dilation. CAE is a relatively uncommon angiographic finding and its prevalence ranges between 0.3 and 5% of patients undergoing coronary angiography. Although its pathophysiology is still unclear, atherosclerosis seems to be the underlying mechanism in most cases. The prognostic role of CAE is also controversial, but previous studies reported a high risk of cardiovascular events and mortality in these patients after percutaneous coronary intervention. Despite the availability of different options for the interventional management of patients with CAE, including covered stent implantation and stent-assisted coil embolization, there is no one standard approach, as therapy is tailored to the individual patient. The abnormal coronary dilation, often associated with high thrombus burden in the setting of acute coronary syndromes, makes the interventional treatment of CAE patients challenging and often complicated by distal thrombus embolization and stent malapposition. Moreover, the optimal antithrombotic therapy is debated and includes dual antiplatelet therapy, anticoagulation, or a combination of them. In this review we aimed to provide an overview of the pathophysiology, classification, clinical presentation, natural history, and management of patients with CAE, with a focus on the challenges for both clinical and interventional cardiologists in daily clinical practice.

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Section: Natural History and Prognostic Stratificationmentioning

confidence: 99%

Treatment and Outcome of Patients With Coronary Artery Ectasia: Current Evidence and Novel Opportunities for an Old Dilemma

Esposito

Maio

Silverio

et al. 2022

Front. Cardiovasc. Med.

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“…This elevated thrombus load is presumably predisposed by the sluggish blood flow observed in ectatic arteries. Notably, coronary artery ectasia [14] has also been associated with angina pectoris and left ventricular dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…However, Mir et al [14] performed a metaanalysis where studies comparing outcomes of PCI in CE versus no-ectasia (NE) STEMI cases were identified. The results showed that both groups had comparable follow-up mortality results with [OR: 0.83, 95% CI 0.39-1.78; p = 0.63].…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Ectasia as a Predictor of Major Adverse Cardiac Events in Patients with Acute ST Elevation Myocardial Infarction

Saad

Gaafar²,

Salama³

et al. 2023

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Background: Coronary artery ectasia (CAE) is characterised as localised or widespread non-obstructive lesions of the epicardial coronary arteries with a luminal dilation more than 1.5 times the neighbouring normal segments or vessel diameter. Isolated CAE is CAE in the absence of severe coronary artery stenosis. This aberrant dilatation of coronary arteries can produce angina pectoris and even myocardial infarction in people without coronary artery disease owing to vasospasm, dissection, or thrombus. The purpose of this study was to evaluate the connection between CAE and major adverse cardiac events (MACE) following acute myocardial infarction with ST elevation. Methods: This was a prospective cohort study which was carried out on 300 cases. Cases were divided into two groups: Group I: including about 22 STEMI cases with CAE and Group II: including about 278 STEMI cases without CAE. All cases in this study were subjected to full history taking, clinical examination, laboratory tests, standard 12-leads ECG, resting transthoracic echocardiography (TTE), and coronary angiography. Results: Regarding MACE in the studied groups, Incidence of reinfarction and cardiac death were significant higher in cases with STEMI and CAE than cases with STEMI alone. In univariate regression analysis, CAE (OR: 3.59, p value =0.022) was a significant predictor of cardiac death but age, male sex, and EF were not. Also, in multivariate regression analysis CAE (OR: 3.49, p value =0.029) was a significant predictor of cardiac death but age, male sex, and EF were not smoking with high warfarin consumption. Further, Markis classification 1 and 3 were the most frequent phenotype among cases. In STEMI cases, the incidence of reinfarction and cardiac death were significantly higher in cases with STEMI and CAE than cases with STEMI alone. So, CAE is a significant predictor of cardiac death.

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“…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. 17 However, these studies focused on patients with CAE and ischemia or angina and no obstructive coronary arteries (INOCA/ANOCA) and the relationship between CAE and myocardial infarction with NOCAD (MINOCA) has been poorly investigated.…”

Section: Introductionmentioning

confidence: 95%

“…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 8–15 . 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 17 .…”

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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Post-PCI outcomes in STEMI patients with coronary ectasia: meta-analysis

Cited by 10 publications

References 21 publications

Treatment and Outcome of Patients With Coronary Artery Ectasia: Current Evidence and Novel Opportunities for an Old Dilemma

Treatment and Outcome of Patients With Coronary Artery Ectasia: Current Evidence and Novel Opportunities for an Old Dilemma

Coronary Artery Ectasia as a Predictor of Major Adverse Cardiac Events in Patients with Acute ST Elevation Myocardial Infarction

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

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