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Published on: April 25, 2014
Coronary ectasia in different scenarios, primarily in myocardial infarction with nonobstructive coronary artery
Gabriele Ghetti1, Francesco Chietera, Francesco Donati
1Department of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy.
Insights
Coronary artery ectasia (CAE) extension is similar across various clinical settings. However, patients with myocardial infarction without obstructive coronary artery disease (MINOCA) showed more extensive CAE.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- Coronary artery ectasia (CAE) is a condition with several reported causes, primarily atherosclerosis and tunica media abnormalities.
- Understanding the factors influencing CAE extension is crucial for patient management.
Purpose of the Study:
- To investigate whether the extension of coronary artery ectasia (CAE) differs across distinct clinical settings.
- To explore the relationship between clinical diagnosis and CAE extension.
Main Methods:
- A retrospective analysis of 341 patients with CAE from 9659 coronary angiographies.
- Patients were categorized by admission diagnosis: stable/unstable angina (S-UA), myocardial infarction (MI), aortic disease, or aortic valvular disease (AVD).
- Subgroup analysis for S-UA and MI based on obstructive coronary artery disease (OCAD); multivariable logistic regression used to assess CAE extension (Markis classification, number of affected vessels).
Main Results:
- No significant differences in CAE extension (vessels affected or Markis class) were observed among the four main clinical groups.
- CAE extension was not directly related to the extent of obstructive coronary artery disease (OCAD) as measured by the Gensini score.
- Patients with myocardial infarction without obstructive coronary artery disease (MINOCA) showed a significantly higher extension of CAE (Markis class 1).
Conclusions:
- The extension of coronary artery ectasia (CAE) is comparable across different clinical scenarios, including S-UA, MI, aortic disease, and AVD.
- Patients presenting with MINOCA demonstrate a greater extension of CAE, highlighting a specific clinical association.
- This finding suggests that MINOCA may be a significant factor associated with more severe CAE extension.
Aims:
Several causes have been reported for coronary artery ectasia (CAE), mostly atherosclerosis and tunica media abnormalities. The main aim of the present study was to investigate if CAE extension differs in distinct clinical settings.
Methods:
Three hundred and forty-one patients with diagnosis of CAE were identified among 9659 coronary angiographies and divided into four groups according to the patient's admission diagnosis: stable or unstable angina (S-UA), myocardial infarction (MI), aortic disease, aortic valvular disease (AVD). S-UA and MI were subgrouped according to the presence of obstructive coronary artery disease (OCAD). Multivariable logistic regression was used to investigate the relationship between clinical diagnosis and CAE extension as expressed by Markis classification and number of coronary vessels affected by CAE.
Results:
No significant differences in CAE extension were found among the four groups, in terms of vessels affected by CAE (P = 0.37) or Markis class (P = 0.33). CAE was not related to the extension of OCAD as assessed by the Gensini score, which was higher in MI and S-UA groups (P < 0.01). However, when ischemic patients were sub-divided on the basis of the presence of OCAD, MI without obstructive coronary artery disease (MINOCA) was associated with a higher extension of CAE in terms of Markis class 1 (OR 5.08, 95% CI 1.61-16.04; P < 0.01).
Conclusion:
The extension of CAE is comparable in patients referred to coronary angiography for different clinical scenarios, including S-UA, MI, aortic disease, and AVD; however, patients with MINOCA were associated with a higher extension of CAE.Graphical abstract: Difference in coronary artery ectasia extension in terms of Markis class severity, respectively, stratified by clinical presentation and obstructive coronary artery disease presence, http://links.lww.com/JCM/A519.
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