Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Int J Cardiol. 2020 Nov 15;319:20-25. doi: 10.1016/j.ijcard.2020.05.054. Epub 2020 Jun 3.
Coronary artery ectasia (CAE) is a rare finding in coronary angiography and associated with worse clinical outcomes. According to the extent of the dilated lesions, CAE is classified into diffuse and focal dilation. The difference in clinical outcomes between these 2 phenotypes remains unknown.
A cohort study was conducted comprising CAE patients identified by coronary angiography between January 2009 to December 2013. Follow-up was proceeded annually and the primary outcome was major adverse cardiovascular events (MACE) defined as a component of cardiovascular death and nonfatal myocardial infarction(MI). Kaplan-Meier method and Cox regression models were used to assess the clinical outcomes in diffuse CAE group and focal CAE group. Propensity score matching, propensity score weighting, and subgroup analysis were performed as sensitivity analysis.
A total of 595 patients were included in this study, including 474 individuals with diffuse CAE and 121 with focal CAE. During a median follow-up of 87 months, Patients in diffuse CAE group showed significantly higher incidences of MACE (13.1% vs. 3.3%;HR 4.28, 95%CI 1.56-11.78, P = .005), as well as cardiovascular death (7.0% vs. 1.7%;HR 4.41, 95%CI 1.06-18.39, P = .041). Higher occurrence rate of MACE was consistent in propensity score matched cohort and propensity score weighted analysis. The same trend towards increased risk of MACE in diffuse CAE group was obtained among subgroup analysis.
Patients with diffuse CAE was associated with increased risk of MACE compared to those with focal CAE. Diffuse dilation found in coronary angiography should receive more attention by physicians.
冠状动脉扩张（CAE）在冠状动脉造影中是一种罕见的发现，并与更差的临床结局相关。根据扩张病变的程度，CAE 分为弥漫性和局限性扩张。这两种表型的临床结局差异尚不清楚。
进行了一项队列研究，纳入了 2009 年 1 月至 2013 年 12 月期间通过冠状动脉造影确定的 CAE 患者。每年进行随访，主要终点是主要不良心血管事件（MACE），定义为心血管死亡和非致死性心肌梗死（MI）的组成部分。使用 Kaplan-Meier 方法和 Cox 回归模型评估弥漫性 CAE 组和局限性 CAE 组的临床结局。进行倾向评分匹配、倾向评分加权和亚组分析作为敏感性分析。
这项研究共纳入了 595 名患者，其中 474 名患者为弥漫性 CAE，121 名患者为局限性 CAE。在中位随访 87 个月期间，弥漫性 CAE 组患者的 MACE 发生率明显更高（13.1%比 3.3%；HR 4.28，95%CI 1.56-11.78，P=0.005），心血管死亡发生率也更高（7.0%比 1.7%；HR 4.41，95%CI 1.06-18.39，P=0.041）。倾向评分匹配队列和倾向评分加权分析中也存在 MACE 发生率较高的情况。在亚组分析中，弥漫性 CAE 组发生 MACE 的风险增加也呈现出相同的趋势。
与局限性 CAE 患者相比，弥漫性 CAE 患者发生 MACE 的风险增加。冠状动脉造影中发现弥漫性扩张应引起医生更多的关注。
