Coronary artery aneurysms, insights from the international coronary artery aneurysm registry (CAAR)
Iván J Núñez-Gil1, Enrico Cerrato2, Mario Bollati3
1Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Insights
Coronary artery aneurysms are relatively common, often linked to coronary stenosis and cardiovascular risk factors. Treatment with antiplatelet therapy and percutaneous coronary intervention is generally safe and effective.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Coronary artery aneurysms are focal dilations of coronary arteries, with reported prevalence varying widely.
- Despite potential clinical significance, coronary artery aneurysms are not well-documented in practice guidelines.
- Limited data exists on the prevalence, management strategies, and long-term outcomes of coronary artery aneurysms.
Purpose of the Study:
- To investigate the prevalence of coronary artery aneurysms.
- To analyze the management approaches for patients with coronary artery aneurysms.
- To evaluate the long-term clinical outcomes in patients diagnosed with coronary artery aneurysms.
Main Methods:
- A retrospective analysis of 436,467 coronary angiograms from 2004-2016 was conducted.
- Data from 1565 patients with coronary artery aneurysms were collected from 32 hospitals across 9 countries.
- Patient demographics, aneurysm characteristics, treatment interventions, and clinical outcomes were analyzed.
Main Results:
- The global prevalence of coronary artery aneurysms was found to be 0.35%.
- Most affected patients were male (78.5%) with a mean age of 65 years, presenting frequently with acute coronary syndrome.
- Aneurysms were often associated with coronary stenosis and aortopathies; percutaneous coronary intervention (PCI) was the commonest revascularization strategy.
Conclusions:
- Coronary artery aneurysms are a notable finding, frequently co-occurring with coronary stenosis and significant cardiovascular risk.
- Antiplatelet therapy is considered a reasonable management strategy.
- Percutaneous coronary intervention demonstrates safety and efficacy in managing coronary artery aneurysms.
Background:
Coronary Aneurysms are a focal dilatation of an artery segment >1.5-fold the normal size of adjacent segments. Although some series have suggested a prevalence of 0.3-12%, data are lacking. In addition, they are not mentioned in practice guidelines. Our aim was investigate its prevalence, management and long-term outcomes.
Methods And Results:
The coronary artery aneurysm registry (CAAR) involved 32 hospitals across 9 countries in America and Europe. We reviewed 436,467 consecutive angiograms performed over the period 2004-2016. Finally, 1565 patients were recruited. Aneurysm global prevalence was 0.35%. Most patients were male (78.5%) with a mean age of 65 years and frequent cardiovascular risk factors. The main indication for angiogram was an acute coronary syndrome, 966 cases. The number of aneurisms was ≤2 per patient in 95.8% of the cases, mostly saccular, most frequently found in the left anterior descending and with numbers proportional with coronary stenosis. Aortopathies were related with more aneurysms too. Most patients received any revascularization procedure (69%), commonly percutaneous (53%). After a median follow-up of 37.2 months, 485 suffered a combined event (MACE) and 240 died. Without major differences comparing CABG vs PCI, MACE and death were more frequent in patients who received bare metal stents.
Conclusions:
Coronary artery aneurysms are not uncommon. Usually, they are associated with coronary stenosis and high cardiovascular risk. Antiplatelet therapy seems reasonable and a percutaneous approach is safe and effective.
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