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
{"title":"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。","authors":"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","doi":"10.57187/s.3857","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Aims: </strong>To assess the clinical characteristics, angiographic patterns, and long-term outcomes in patients with CAE, CAA, or both.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"155 ","pages":"3857"},"PeriodicalIF":2.1000,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Outcomes of coronary artery aneurysms: insights from the Coronary Artery Ectasia and Aneurysm Registry (CAESAR).\",\"authors\":\"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\",\"doi\":\"10.57187/s.3857\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Aims: </strong>To assess the clinical characteristics, angiographic patterns, and long-term outcomes in patients with CAE, CAA, or both.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":22111,\"journal\":{\"name\":\"Swiss medical weekly\",\"volume\":\"155 \",\"pages\":\"3857\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-01-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Swiss medical weekly\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.57187/s.3857\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Swiss medical weekly","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.57187/s.3857","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
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。
Outcomes of coronary artery aneurysms: insights from the Coronary Artery Ectasia and Aneurysm Registry (CAESAR).
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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