Anticoagulant versus Antiplatelet Therapy After Acute Coronary Syndromes in Patients with Coronary Artery Ectasia: A Retrospective Cohort Study.

Purpose: Patients with coronary ectasia (CAE) have an increased risk of major cardiovascular events (MACE). Current preventive treatments are uncertain, with oral anticoagulants often prescribed based on limited retrospective studies. Our aim is to help address the question: what is the most appropriate treatment?

Methods: Using a retrospective cohort of patients with an ACS and CAE in a single center in Mexico City, two groups were observed based on the treatment at discharge: dual antiplatelet therapy (group 1) and anticoagulation with either a VKA or a DOAC, regardless of antiplatelet therapy (group 2). The main outcome was MACE, which was a composite of all-cause mortality, reinfarction, and ischemic stroke at 4.5 years follow-up.

Results: A total of 354 patients admitted for ACS and CAE were included. 228 (64.4%) patients were classified in the DAPT group and 126 (35.5%) in the anticoagulants group. The DAPT group had higher type 2 diabetes rates, NSTEMI presentation, and lower-grade ectasia. The anticoagulation group had higher STEMI presentation and higher-grade ectasia. The DAPT group had 33 (14.5%) events of MACE, whereas the anticoagulation group had 16 (13.1%) events. Anticoagulants were not associated with a risk reduction of the primary endpoint (HR 0.95; 95% CI, 0.47-1.54; p = 0.59), nor any of the individual components.

Conclusion: This retrospective cohort study showed similar effectiveness between DAPT and anticoagulation in patients with ACS and CAE for preventing MACE, and lower bleeding risk. Further research is needed to identify optimal candidates for each antithrombotic regime.