Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA.
Open Heart. 2021 Feb;8(1). doi: 10.1136/openhrt-2020-001440.
Coronary artery aneurysms (CAAs) are increasingly diagnosed on coronary angiography; however, controversies persist regarding their optimal management. In the present study, we analysed the long-term outcomes of patients with CAAs following three different management strategies.
We performed a retrospective review of patient records with documented CAA diagnosis between 2000 and 2005. Patients were divided into three groups: medical management versus percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). We analysed the rate of major cardiovascular and cerebrovascular events (MACCEs) over a period of 10 years.
We identified 458 patients with CAAs (mean age 78±10.5 years, 74.5% men) who received medical therapy (N=230) or underwent PCI (N=52) or CABG (N=176). The incidence of CAAs was 0.7% of the total catheterisation reports. The left anterior descending was the most common coronary artery involved (38%). The median follow-up time was 62 months. The total number of MACCE during follow-up was 155 (33.8%); 91 (39.6%) in the medical management group vs 46 (26.1%) in the CABG group vs 18 (34.6%) in the PCI group (p=0.02). Kaplan-Meier survival analysis showed that CABG was associated with better MACCE-free survival (p log-rank=0.03) than medical management. These results were confirmed on univariate Cox regression, but not multivariate regression (OR 0.773 (0.526 to 1.136); p=0.19). Both Kaplan-Meier survival and regression analyses showed that dual antiplatelet therapy (DAPT) and anticoagulation were not associated with significant improvement in MACCE rates.
Our analysis showed similar long-term MACCE risks in patients with CAA undergoing medical, percutaneous and surgical management. Further, DAPT and anticoagulation were not associated with significant benefits in terms of MACCE rates. These results should be interpreted with caution considering the small size and potential for selection bias and should be confirmed in large, randomised trials.
冠状动脉瘤（CAA）在冠状动脉造影中的检出率越来越高；然而，其最佳治疗方法仍存在争议。本研究分析了三种不同治疗策略下 CAA 患者的长期预后。
我们对 2000 年至 2005 年间有记录的 CAA 诊断的患者病历进行了回顾性分析。患者分为三组：药物治疗组、经皮冠状动脉介入治疗（PCI）组和冠状动脉旁路移植术（CABG）组。我们分析了 10 年内主要心血管和脑血管事件（MACCE）的发生率。
我们共纳入了 458 例 CAA 患者（平均年龄 78±10.5 岁，74.5%为男性），其中 230 例接受了药物治疗，52 例行 PCI，176 例行 CABG。CAA 的发生率占总导管报告的 0.7%。最常见的受累冠状动脉为左前降支（38%）。中位随访时间为 62 个月。随访期间共发生 MACCE 155 例（33.8%）；药物治疗组 91 例（39.6%），CABG 组 46 例（26.1%），PCI 组 18 例（34.6%）（p=0.02）。Kaplan-Meier 生存分析显示，与药物治疗相比，CABG 可改善 MACCE 无事件生存率（p log-rank=0.03）。单因素 Cox 回归分析结果一致，但多因素回归分析结果不一致（OR 0.773（0.526 至 1.136）；p=0.19）。Kaplan-Meier 生存分析和回归分析均显示，双联抗血小板治疗（DAPT）和抗凝治疗与 MACCE 发生率的显著改善无关。
本研究分析表明，CAA 患者接受药物、经皮和手术治疗的长期 MACCE 风险相似。此外，DAPT 和抗凝治疗并不能显著降低 MACCE 发生率。鉴于样本量小且存在选择偏倚的可能性，这些结果应谨慎解释，还需在大型随机试验中进一步证实。
