Management and Outcomes of Coronary Artery Aneurysms: A Patient-Level Systematic Review.

Q3 Medicine

Critical Pathways in Cardiology Pub Date : 2025-06-01 Epub Date: 2025-05-23 DOI:10.1097/HPC.0000000000000381

Daler Rahimov, Nayeem Nasher, Danial Ahmad, Rohinton J Morris, Anjali Upadhyaya, Colin Yost, Daniella Wong, Preeyal Patel, Alec Vishnevsky, Nicholas J Ruggiero, John W Entwistle, Vakhtang Tchantchaleishvili

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引用次数: 0

Abstract

Background: Data are lacking to guide standardized management of coronary artery aneurysms (CAAs). We sought to analyze the available evidence in a quantitative manner.

Methods: An electronic search identified 431 case reports or case series on CAA, comprising 488 patients. Patient-level data were extracted. Subgroups of CAA with fistulous connections (CAAF) and CAA without fistulous connections (CAAO) were analyzed separately.

Results: Fistulous connection was present in 24.0% (117/488) of patients with CAA. Angina was a presenting symptom in 64.7% (301/465), with higher preponderance in the CAAO group [CAAO: 71.1% (249/350) versus CAAF: 45.2% (52/115); P < 0.01]. The median largest aneurysm diameter was higher in the CAAF group [CAAO: 3.0 (1.5-5.0) cm versus CAAF: 5.0 (3.0-7.0) cm; P < 0.01], and rupture was more frequently observed in the CAAF group [CAAO: 3.1% (11/353) versus CAAF: 13.8% (16/116); P < 0.01]. For any given diameter, CAAF had a higher risk of rupture compared with CAAO. Surgery was the most common management strategy, particularly in patients with CAAF [CAAO: 50.9% (189/371) versus CAAF: 75.2% (88/117); P < 0.01]. The Kaplan-Meier analysis showed a trend toward more favorable survival in CAAF. The hazard of mortality was associated with aneurysm diameter in both subsets but was higher in the CAAO group independent of surgical versus interventional management.

Conclusions: CAAF appears to have a higher risk of rupture but may be associated with better survival than CAAO. Management for patients with CAA differs based on the presence or absence of a fistula; however, both surgical and interventional modes of management result in similar survival.

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冠状动脉瘤的治疗和预后：一项患者水平的系统综述。

背景：缺乏指导冠状动脉瘤（CAA）规范化治疗的数据。我们试图以定量的方式分析现有的证据。方法：电子检索431例CAA病例报告或病例系列，包括488例患者。提取患者层面的数据。有（CAAF）和无（CAAO）亚组分别进行分析。结果：24.0%（117/488）的CAA患者存在瘘连接。64.7%（301/465）的患者以心绞痛为主要症状，CAAO组的发生率更高[CAAO组：71.1% (249/350)vs CAAF组：45.2%(52/115)]。结论：CAAF似乎有更高的破裂风险，但可能比CAAO有更好的生存。CAA患者的治疗方法因是否存在瘘而不同，然而，手术和介入治疗的生存率相似。

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

Critical Pathways in Cardiology Medicine-Medicine (all)

CiteScore

1.90

自引率

0.00%

发文量

期刊介绍： Critical Pathways in Cardiology provides a single source for the diagnostic and therapeutic protocols in use at hospitals worldwide for patients with cardiac disorders. The Journal presents critical pathways for specific diagnoses—complete with evidence-based rationales—and also publishes studies of these protocols" effectiveness.