Antithrombotic Therapy in Coronary Artery Aneurysm, Ectasia, and Slow Flow: A Systematic Review

IF 2.8 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology Pub Date : 2026-09-25 DOI:10.1002/clc.70471

Nasim Kheirandish, Maliheh Kamali, Alireza Khodadadiyan, Helia Bazroodi, Mohammadhossein Imani, Sahar Ghahramani, Amirhossein Saem, Amirhossein Imani, Haniyeh Alaei, Alireza Abdi-Ardekani, Saideh Jamshidi, Mehdi Bazrafshan, Alireza Arzhangzade, Zahra Hooshanginezhad, Hamed Bazrafshan Drissi

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引用次数: 0

Abstract

Background

Coronary artery aneurysm (CAA), coronary artery ectasia (CAE), and coronary slow flow phenomenon (CSFP) are coronary pathologies associated with altered hemodynamics and increased thrombotic risk. However, optimal antithrombotic management remains uncertain because of limited and heterogeneous evidence.

Objectives

This systematic review aimed to synthesize data on the efficacy and safety of antiplatelet and anticoagulant therapies in patients with CAA, CAE, and CSFP.

Methods

Following PRISMA 2020 guidelines, PubMed, Scopus, Web of Science, and ProQuest were searched through September 2025 for randomized and observational studies evaluating antithrombotic therapy in adults with these conditions. Outcomes included major adverse cardiovascular events and major bleeding. Narrative synthesis was conducted using the SWiM framework. Risk of bias was assessed using ROBINS-I and RoB 2.0, and certainty of evidence using GRADE.

Results

Eleven studies comprising 3271 participants were included: six on CAE (n = 895), four on CAA (n = 2356), and one on CSFP (n = 20). In CAE, dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC) were associated with fewer ischemic events than no therapy, although direct comparisons were inconsistent. The only randomized trial in CAE showed numerically lower recurrent myocardial infarction and cardiovascular death with single antiplatelet therapy (SAPT) plus direct oral anticoagulant (DOAC) versus DAPT, but findings were nonsignificant and based on few events. Evidence for CAA and CSFP remains limited and inconclusive.

Conclusions

Intensified antithrombotic therapy may benefit patients with CAE, but evidence remains inconclusive for CAA and CSFP. Large, multicenter randomized trials are warranted to establish condition-specific treatment recommendations.

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冠状动脉动脉瘤、扩张和血流缓慢的抗血栓治疗：系统综述。

背景：冠状动脉动脉瘤（CAA）、冠状动脉扩张（CAE）和冠状动脉慢血流现象（CSFP）是与血流动力学改变和血栓形成风险增加相关的冠状动脉病变。然而，最佳的抗血栓管理仍然不确定，因为有限的和不均匀的证据。目的：本系统综述旨在综合有关CAA、CAE和CSFP患者抗血小板和抗凝治疗的有效性和安全性的数据。方法：遵循PRISMA 2020指南，检索PubMed、Scopus、Web of Science和ProQuest，检索2025年9月之前评估这些疾病成人抗血栓治疗的随机和观察性研究。结果包括主要不良心血管事件和大出血。使用SWiM框架进行叙事综合。使用ROBINS-I和rob2.0评估偏倚风险，使用GRADE评估证据的确定性。结果：11项研究包括3271名参与者：6项CAE (n = 895)， 4项CAA (n = 2356)， 1项CSFP （n = 20）。在CAE中，双重抗血小板治疗（DAPT）和口服抗凝治疗（OAC）与不治疗相比，缺血性事件较少，尽管直接比较不一致。CAE中唯一的随机试验显示，与DAPT相比，单抗血小板治疗（SAPT）加直接口服抗凝剂（DOAC）的复发性心肌梗死和心血管死亡在数值上更低，但研究结果不显著，且基于少数事件。CAA和CSFP的证据仍然有限且不确定。结论：强化抗血栓治疗可能对CAE患者有益，但对于CAA和CSFP的疗效尚无定论。需要进行大型、多中心随机试验，以确定具体的治疗建议。

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

Clinical Cardiology 医学-心血管系统

CiteScore

5.10

自引率

3.70%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.