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Management and Outcomes of Coronary Artery Aneurysms: A Patient-Level Systematic Review

Daler Rahimov1, Nayeem Nasher1, Danial Ahmad1

  • 1Department of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA.

Critical Pathways in Cardiology
|February 4, 2025
PubMed

Insights

Coronary artery aneurysms (CAAs) with fistulous connections (CAAF) have higher rupture risk but better survival. Management strategies vary, but both surgical and interventional approaches yield similar survival outcomes for CAAs.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Medical Research

Background:

  • Standardized management guidelines for coronary artery aneurysms (CAAs) are lacking.
  • This study quantitatively analyzes existing evidence on CAA management.

Purpose of the Study:

  • To compare outcomes and management strategies for CAAs with fistulous connections (CAAF) versus those without (CAAO).
  • To provide data-driven insights for guiding CAA treatment.

Main Methods:

  • Systematic electronic search of 431 case reports/series on CAA, including 488 patients.
  • Extraction and analysis of patient-level data, comparing CAAF and CAO subgroups.
  • Kaplan-Meier survival analysis and hazard assessment based on aneurysm characteristics.

Main Results:

  • CAAF patients exhibited a higher median aneurysm diameter and significantly increased rupture risk compared to CAAO.
  • Angina was a more frequent presenting symptom in CAAO, while surgery was the predominant management for CAAF.
  • Despite higher rupture risk, CAAF showed a trend toward more favorable survival, with mortality associated with aneurysm diameter in both groups.

Conclusions:

  • CAAF presents a higher rupture risk but potentially better survival than CAAO.
  • Management of CAAs should be tailored to the presence or absence of a fistula.
  • Both surgical and interventional management strategies for CAAs result in comparable survival rates.
Abstract

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