Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Interventional Cardiology, Infermi Hospital, Rivoli, Turin, Italy.
Int J Cardiol. 2020 Jan 15;299:49-55. doi: 10.1016/j.ijcard.2019.05.067. Epub 2019 Jul 19.
Coronary Aneurysms are a focal dilatation of an artery segment >1.5-fold the normal size of adjacent segments. Although some series have suggested a prevalence of 0.3-12%, data are lacking. In addition, they are not mentioned in practice guidelines. Our aim was investigate its prevalence, management and long-term outcomes.
The coronary artery aneurysm registry (CAAR) involved 32 hospitals across 9 countries in America and Europe. We reviewed 436,467 consecutive angiograms performed over the period 2004-2016. Finally, 1565 patients were recruited. Aneurysm global prevalence was 0.35%. Most patients were male (78.5%) with a mean age of 65 years and frequent cardiovascular risk factors. The main indication for angiogram was an acute coronary syndrome, 966 cases. The number of aneurisms was ≤2 per patient in 95.8% of the cases, mostly saccular, most frequently found in the left anterior descending and with numbers proportional with coronary stenosis. Aortopathies were related with more aneurysms too. Most patients received any revascularization procedure (69%), commonly percutaneous (53%). After a median follow-up of 37.2 months, 485 suffered a combined event (MACE) and 240 died. Without major differences comparing CABG vs PCI, MACE and death were more frequent in patients who received bare metal stents.
Coronary artery aneurysms are not uncommon. Usually, they are associated with coronary stenosis and high cardiovascular risk. Antiplatelet therapy seems reasonable and a percutaneous approach is safe and effective.
冠状动脉瘤是指动脉节段的局部扩张，超过相邻节段正常大小的 1.5 倍。尽管有些系列报道显示其患病率为 0.3%-12%，但目前仍缺乏相关数据。此外，该病症在实践指南中也并未提及。我们旨在研究其患病率、治疗方法和长期预后。
冠状动脉瘤登记（CAAR）涉及 9 个国家的 32 家医院。我们回顾了 2004 年至 2016 年期间进行的 436467 例连续血管造影。最终，共纳入了 1565 名患者。动脉瘤的总体患病率为 0.35%。大多数患者为男性（78.5%），平均年龄为 65 岁，且常伴有心血管危险因素。进行血管造影的主要指征是急性冠状动脉综合征，共 966 例。95.8%的患者每个患者的动脉瘤数量≤2 个，大多数为囊状，最常发生在前降支，数量与冠状动脉狭窄成正比。大血管病变也与更多的动脉瘤相关。大多数患者接受了任何血运重建治疗（69%），其中最常见的是经皮介入治疗（53%）。在中位数为 37.2 个月的随访中，有 485 名患者发生了复合终点事件（MACE），240 名患者死亡。在比较 CABG 与 PCI 时，尽管无明显差异，但裸金属支架组的 MACE 和死亡更为常见。
冠状动脉瘤并不罕见。通常，它们与冠状动脉狭窄和高心血管风险相关。抗血小板治疗似乎是合理的，经皮介入治疗是安全有效的。
