Coronary aneurysms in the acute patient: Incidence, characterization and long-term management results
Iván J Núñez-Gil1, Belén Terol2, Gisela Feltes2
1Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain..
Insights
Coronary aneurysms are uncommon in acute patients but linked to significant atherosclerotic risk factors. Long-term cardiovascular complications are frequent, though rarely directly caused by the aneurysm itself.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Coronary aneurysms, defined as a 1.5-fold dilation of the reference vessel, are increasingly diagnosed via coronary angiography, with an incidence ranging from 1.5% to 5%.
- Complications include thrombosis, embolization, rupture, and vasospasm, potentially leading to ischemia, heart failure, or arrhythmias.
- The natural history and long-term prognosis of coronary aneurysms remain incompletely understood.
Purpose of the Study:
- To characterize acute patients diagnosed with coronary aneurysms.
- To investigate the prevalence and clinical presentation of coronary aneurysms in an acute setting.
- To evaluate the long-term outcomes and complications associated with coronary aneurysms.
Main Methods:
- Prospective analysis of a coronariography registry from 2002 to 2013.
- Inclusion of 414 patients with coronary aneurysms from 51,555 consecutive coronary angiograms.
- Focus on 256 acute patients, with 82% classified as non-ST-elevation acute coronary syndrome (NSTE-ACS).
Main Results:
- The study population was predominantly male (80%) with a mean age of 65.5 years.
- High prevalence of cardiovascular risk factors: hypertension (65%), dyslipidemia (65%), diabetes mellitus (28.5%), and smoking (67%).
- Frequent coronary stenoses (94%) and aneurysms, primarily in the anterior descending artery. Median follow-up of 52 months revealed 14% mortality (14% cardiac causes) and 42% experienced cardiovascular events. Aneurysm-related complications occurred in 4%.
Conclusions:
- Coronary aneurysms in acute patients are infrequent but associated with a substantial burden of atherosclerotic risk factors.
- Long-term cardiovascular complications are common, but a small fraction are directly attributable to the aneurysm.
- Intensified and prolonged dual antiplatelet therapy may reduce mortality rates.
Background:
Coronary aneurysms (1.5 times dilation the reference-vessel) are uncommon and have been diagnosed with increasing frequency with coronary angiography. The incidence varies from 1.5% to 5%. Reported complications are multiple: thrombosis, distal embolization, rupture and vasospasm, causing ischemia, heart failure or arrhythmias. However, the natural history and prognosis remains obscure. We aimed to describe the characteristics of acute patients with coronary aneurysms.
Methods:
Prospective coronariography registry of patients with the diagnosis of coronary aneurysm between 2002 and 2013. Among 51,555 consecutive coronary angiograms, 414 patients with aneurysms were reported, of which 256 were considered acute (82% NSTE-ACS).
Results:
Predominantly male (80%, mean age 65.5years), cardiovascular risk factors were common (hypertension 65%, dyslipidemia 65%, obesity 25%, diabetes mellitus 28.5%, and smokers 67%). With frequent coronary stenoses (94%), mostly with one aneurysm (80%), it was observed more frequently in the anterior descending artery. After a median follow-up of 52months, 53 died (14 cardiac causes) and 42% presented a cardiovascular event. Complications from the aneurysm were found in 4. The duration of dual antiplatelet therapy, LVEF, age and peripheral vascular disease highlighted in the multivariate analysis of death.
Conclusion:
The presence of coronary aneurysms in patients undergoing coronary angiography with an acute event is low. Patients who present them also have a large burden of atherosclerotic risk factors. In the long-term, the probability of cardiovascular complications is high, but only a small proportion are due to the aneurysm itself. A more intense and prolonged antithrombotic treatment may result in lower mortality rates.
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