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Coronary Ectasia and ST Elevation Myocardial Infarction Patients: Does Atherosclerosis Influence Periprocedural
Victorine Fraichot1, Jeanne Varlot1, Florian Eggenspieler1
1Department of Cardiology, Université de Lorraine, CHRU-Nancy, Nancy, France.
Insights
Patients with ST-elevation myocardial infarction (STEMI) and coronary artery ectasia (CAE) show different procedural outcomes based on the presence of coronary atherosclerosis. This study highlights distinct periprocedural characteristics, influencing treatment strategies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Coronary artery ectasia (CAE) impacts procedural outcomes in ST-elevation myocardial infarction (STEMI).
- The relationship between CAE and atherosclerotic coronary artery disease (ACAD) in STEMI patients is not well-defined.
- Understanding these associations is crucial for optimizing patient management.
Purpose of the Study:
- To compare clinical and procedural characteristics of STEMI patients with CAE.
- To evaluate outcomes in STEMI patients with CAE, stratified by the presence or absence of coexisting ACAD.
- To identify differences in periprocedural management and outcomes between isolated CAE and CAE with ACAD.
Main Methods:
- A cohort of 148 STEMI patients with ectatic infarct-related arteries undergoing primary percutaneous intervention (PCI) was analyzed.
- Patients were divided into two groups: isolated CAE (n=74) and CAE with coexisting ACAD (n=74).
- Clinical data, procedural details, and 3-year follow-up outcomes were compared between the groups.
Main Results:
- Patients with CAE and ACAD were older and underwent more frequent coronary angioplasty and stenting compared to those with isolated CAE.
- A trend towards less frequent distal embolization was observed in the CAE with ACAD group.
- No significant differences were found in cardiac enzyme levels, left ventricular ejection fraction, or 3-year major adverse cardiovascular event (MACE)-free rates between the groups.
Conclusions:
- STEMI patients with ectatic infarct-related arteries exhibit distinct periprocedural characteristics based on the presence of coronary atherosclerosis.
- The findings suggest that coexisting ACAD influences procedural interventions in STEMI patients with CAE.
- Further research is warranted to establish optimal therapeutic strategies for these patients at discharge.
Background:
Coronary artery ectasia (CAE) influences procedural outcomes in the context of ST-elevation myocardial infarction (STEMI); however, its relationship with atherosclerotic coronary artery disease (ACAD) remains unclear.
Aims:
This study aimed to compare clinical and procedural characteristics, as well as outcomes, in patients with STEMI and CAE, with or without coexisting ACAD.
Methods:
Overall, 148 patients with STEMI and ectatic infarct-related artery who underwent primary percutaneous intervention were included from 2003 to 2021. These patients were stratified based on the presence of atherosclerotic disease into two groups: patients with STEMI and isolated CAE (n = 74) and those with CAE and coexisting ACAD (n = 74).
Results:
Compared with patients in the isolated CAE group, those in the CAE and coexisting ACAD groups were older (65 vs. 58.4 year, p = 0.002), with no significant differences in cardiovascular risk factors or initial clinical presentation. Coronary angioplasty was performed more frequently in the CAE with coexisting ACAD group (90.5% vs. 63.7%, p < 0.001), with a higher stenting rate (73.0% vs. 48.6%, p = 0.004) and a trend toward less frequent distal embolization (35.3% vs. 52.9%, p = 0.057). No significant differences were observed between the two groups in troponin or CPK levels, nor in left ventricular ejection fraction at hospital discharge (48 ± 10% vs. 49 ± 10%, p = 0.569). At the 3-year follow-up, the overall MACE-free rate was 85.1%, with no significant difference between the groups (83.8% vs. 78.4%, p = 0.487).
Conclusion:
Patients with STEMI and ectatic related infarct-related artery who underwent primary PCI demonstrated distinct periprocedural characteristics depending on the presence or absence of coronary atherosclerosis. Further research is needed to determine optimal therapeutic management at discharge.
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