Outcomes of coronary artery aneurysms: insights from the Coronary Artery Ectasia and Aneurysm Registry (CAESAR).

IF 2.1 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Swiss medical weekly Pub Date : 2025-01-06 DOI:10.57187/s.3857

Alessandro Candreva, Jessica Huwiler, Diego Gallo, Victor Schweiger, Thomas Gilhofer, Roberta Leone, Michael Würdinger, Maurizio Lodi Rizzini, Claudio Chiastra, Julia Stehli, Jonathan Michel, Alexander Gotschy, Barbara E Stähli, Frank Ruschitzka, Umberto Morbiducci, Christian Templin

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引用次数: 0

Abstract

Background: Coronary artery ectasias and aneurysms (CAE/CAAs) are among the less common forms of coronary artery disease, with undefined long-term outcomes and treatment strategies.

Aims: To assess the clinical characteristics, angiographic patterns, and long-term outcomes in patients with CAE, CAA, or both.

Methods: This 15-year (2006-2021) retrospective single-centre registry included 281 patients diagnosed with CAE/CAA via invasive coronary angiography. Major adverse cardiovascular events included all-cause death, non-fatal myocardial infarction, unplanned ischaemia-driven revascularisation, hospitalisation for heart failure, cerebrovascular events, and clinically overt bleeding. Time-dependent event risks for the CAE and CAA groups were assessed using Cox regression models and Kaplan-Meier curves.

Results: CAEs (n = 161, 57.3%) often had a multi-district distribution (45.8%), while CAAs (78, 27.8%) exhibited a single-vessel pattern (80%). The co-existence of CAAs and CAE was observed in 42 cases (14.9%), and multi-vessel obstructive coronary artery disease was prevalent (55.9% overall). Rates of major adverse cardiovascular events were 14.3% in-hospital and 38.1% at a median follow-up of 18.9 (interquartile range [IQR] 6.0-39.9) months. The presence of CAAs was associated with increased major adverse cardiovascular events risk in comparison to CAE (hazard ratio [HR] = 2.26, 95% confidence interval [CI] 1.38-3.69, p = 0.001), driven by a higher hazard ratio of non-fatal myocardial infarctions (HR = 5.00, 95% CI 1.66-15.0, p = 0.004) and unplanned ischaemia-driven revascularisation in both dilated (HR = 3.23, 95% CI 1.40-7.45, p = 0.006) and non-dilated coronary artery segments (HR 3.83, 95% CI 2.08-7.07, p = 0.001).

Conclusions: Overlap between obstructive and dilated coronary artery disease is frequent. Among the spectrum of dilated coronary artery disease, the presence of a CAA was associated with worse long-term outcomes.

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冠状动脉瘤的预后：来自冠状动脉扩张和动脉瘤登记（CAESAR）的见解。

背景：冠状动脉扩张和动脉瘤（CAE/CAAs）是冠状动脉疾病中较不常见的形式之一，其长期预后和治疗策略尚不明确。目的：评估CAE、CAA或两者兼有患者的临床特征、血管造影模式和长期预后。方法：这项为期15年（2006-2021）的回顾性单中心登记包括281例通过有创冠状动脉造影诊断为CAE/CAA的患者。主要不良心血管事件包括全因死亡、非致死性心肌梗死、计划外缺血驱动的血运重建术、因心力衰竭住院、脑血管事件和临床明显出血。采用Cox回归模型和Kaplan-Meier曲线对CAE组和CAA组的时间相关事件风险进行评估。结果：CAEs （n = 161, 57.3%）多呈多区分布（45.8%），CAAs（78, 27.8%）多呈单血管分布（80%）。CAAs和CAE并存42例（14.9%），多支阻塞性冠状动脉病变普遍存在（55.9%）。在中位随访18.9个月（四分位间距[IQR] 6.0-39.9）个月期间，主要心血管不良事件发生率为14.3%,38.1%。农科院的存在是与主要不良心血管事件风险增加有关相比CAE(危险比[HR] = 2.26, 95%可信区间(CI) 1.38 - -3.69, p = 0.001),由非致命性心肌梗死的风险比更高(HR = 5.00, 95% CI 1.66 - -15.0, p = 0.004)和计划外ischaemia-driven血管形成在扩张(HR = 3.23, 95% CI 1.40 - -7.45, p = 0.006)和non-dilated冠状动脉段(HR 3.83, 95%可信区间2.08 - -7.07,p = 0.001)。结论：阻塞性冠状动脉病变与扩张性冠状动脉病变重叠较多。在扩张型冠状动脉疾病中，CAA的存在与较差的长期预后相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Swiss medical weekly 医学-医学：内科

CiteScore

5.00

自引率

0.00%

发文量

审稿时长

3-8 weeks

期刊介绍： The Swiss Medical Weekly accepts for consideration original and review articles from all fields of medicine. The quality of SMW publications is guaranteed by a consistent policy of rigorous single-blind peer review. All editorial decisions are made by research-active academics.