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Coronary artery aneurysms: outcomes following medical, percutaneous interventional and surgical management

Shameer Khubber1, Rajdeep Chana1, Chandramohan Meenakshisundaram1

  • 1Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Open Heart
|February 11, 2021
PubMed

Insights

Long-term outcomes for coronary artery aneurysms (CAAs) show similar risks across medical, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) management. Dual antiplatelet therapy and anticoagulation did not significantly improve major adverse cardiovascular and cerebrovascular events (MACCEs).

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Interventional Cardiology

Background:

  • Coronary artery aneurysms (CAAs) are increasingly diagnosed, yet optimal management remains debated.
  • This study investigates long-term outcomes of different treatment strategies for CAAs.

Purpose of the Study:

  • To compare the long-term effectiveness of medical management, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) for coronary artery aneurysms (CAAs).
  • To evaluate the impact of dual antiplatelet therapy (DAPT) and anticoagulation on major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with CAAs.

Main Methods:

  • Retrospective review of 458 patients diagnosed with CAAs between 2000 and 2005.
  • Patients were stratified into medical management, PCI, or CABG groups.
  • Analysis of major cardiovascular and cerebrovascular events (MACCEs) over a 10-year follow-up period using Kaplan-Meier survival analysis and Cox regression.

Main Results:

  • Coronary artery bypass grafting (CABG) showed a trend towards better MACCE-free survival compared to medical management (p log-rank=0.03).
  • No significant difference in MACCE rates was observed between the three management groups in multivariate analysis.
  • Dual antiplatelet therapy (DAPT) and anticoagulation did not demonstrate a significant benefit in reducing MACCE rates.

Conclusions:

  • Long-term MACCE risks appear similar across medical, PCI, and CABG management strategies for CAAs.
  • DAPT and anticoagulation offer no significant advantage in reducing MACCE rates for CAA patients.
  • Findings require confirmation in larger, randomized trials due to study limitations such as small sample size and potential selection bias.
Abstract

Keywords:
coronary aneurysmcoronary artery diseasecoronary vesselspercutaneous coronary intervention

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