Long-Term Outcomes of Conservative Versus Invasive Approach of Coronary Aneurysm
Anthony Matta1,2,3,4, Francisco Campelo-Parada1, Vanessa Nader1,3
1Department of Cardiology, Toulouse University Hospital (Hopital Rangeuil), 31400 Toulouse, France.
Insights
Management of coronary artery aneurysms (CAA) remains unclear. This study found no significant difference in major adverse cardiovascular events between medical, PCI, or CABG treatments for CAA, though larger aneurysms predicted worse outcomes.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Cardiology
Background:
- Coronary artery aneurysm (CAA) management lacks standardized guidelines, relying on individual clinical decisions.
- Existing literature on CAA treatment outcomes is limited and often contradictory.
Purpose of the Study:
- To compare the long-term outcomes of different therapeutic strategies for coronary artery aneurysms (CAA).
- Investigate the effectiveness of medical management, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) for CAA.
Main Methods:
- Retrospective cohort study of 100 patients diagnosed with CAA via coronary angiography.
- Data collected included patient demographics, aneurysm characteristics, and treatment strategies.
- Major adverse cardiovascular and cerebrovascular events (MACCE) were tracked during follow-up.
Main Results:
- The study identified 100 CAA patients, with the left anterior descending artery most frequently affected (36%).
- 78% of patients had associated significant coronary artery disease.
- No statistically significant difference in MACCE rates was observed between medical, PCI, and CABG groups (12.8%, 14.3%, and 9.1% respectively).
- Larger aneurysm diameter was a significant predictor of MACCE (OR = 1.109, p = 0.024).
Conclusions:
- No significant differences in MACCE-free survival were found between medical, PCI, and CABG treatments for coronary artery aneurysms.
- Longitudinal aneurysm diameter emerged as a key predictor of poorer prognosis in CAA patients.
Introduction:
Up to date, the management of coronary artery aneurysm (CAA) is not well defined and depends on local heart team decision. Data reported in literature are scarce and controversial. We aim to compare the long-term outcomes of different therapeutic strategies of CAA (medical vs percutaneous coronary intervention (PCI) vs coronary artery bypass graft(CABG)).
Materials And Methods:
A retrospective cohort study was conducted on 100 consecutive patients who underwent coronary angiography at Toulouse University Hospital, Toulouse France and fulfilled the diagnostic criteria of CAA. Coronary angiograms were reviewed, and all necessary data were collected. CAA was defined by a coronary dilation exceedingly at least 50% of reference coronary diameter.
Results:
We identified 100 patients with CAA with a mean age of 67.9 12 years. The left anterior descending coronary artery was most affected (36%). CAA is associated with significant coronary artery disease in 78% of cases. The incidence of major adverse cardiovascular and cerebrovascular events (MACCE) was 13% during a median follow-up period of 46.2 24 months. A 53% of patients underwent PCI or CABG. The rate of MACCE was lower in CABG group (9.1%) compared to PCI (14.3%) and medical (12.8%) groups, but without reaching statistically significant level. Longitudinal aneurysm diameter was positively linked to MACCE [OR = 1.109, 95% CI (1.014-1.214), p = 0.024]. No benefits have been attributed to anticoagulant regimen over antiplatelet therapy.
Conclusions:
In our retrospective observational study, there seems to be no significant differences in MACCE-free survival between all groups (Medical vs PCI vs CABG). Larger longitudinal aneurysm diameter was identified as a predictor of poor prognosis during follow-up.
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