Mir Tanveer, Sattar Yasar, Uddin Mohammed, Changal Khalid Hamid, Kumar Kartik, Attique Hassan Bin, Kabashneh Sohaip, Ullah Waqas, Lohia Prateek, Alraies M Chadi, Blank Nimrod, Afonso Luis, Qureshi Waqas T
Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, USA.
Department of Internal medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
Expert Rev Cardiovasc Ther. 2021 Apr;19(4):349-356. doi: 10.1080/14779072.2021.1889370. Epub 2021 Apr 14.
Coronary ectasia (CE) is defined as dilation of the coronary artery, 1.5 times that of the surrounding vessel. Outcomes of percutaneous intervention (PCI) in patients with CE presenting as ST-elevated myocardial infarction (STEMI) remain a topic of debate.
Studies comparing outcomes of PCI in CE versus no-ectasia (NE) STEMI patients were identified. Baseline angiographic characteristics include thrombolysis in myocardial infarction (TIMI) 0-1 flow, right coronary artery (RCA) involvement, and primary outcomes including thrombus aspiration, no-reflow, mortality, and TIMI-3 post-PCI. Odds ratio (OR) and 95% confidence interval (CI) were calculated.
Six studies (n = 5746, CE-340 and NE-5406) qualified for the analysis. RCA involvement was more common in CE than NE, OR-1.39 (95%CI1.06-1.82, p-0.02). Pre-procedure TIMI-0-1 was of comparable results between the groups (p-1.13). Higher thrombus aspiration for CE (OR 2.18, 95%CI1.44-3.32;p-<0.001). CE had higher incidence of no-reflow (OR 4.07, 95%CI2.42-6.84;p-<0.001). TIMI-3 flow post-PCI was achieved less commonly in the CE group (OR-0.64, 95%CI-0.48-0.86;p-<0.001). Mortality on follow-up was comparable (0.83, 95%CI0.39-1.78;p-0.63). Metaregression analysis did not show confounding effects from comorbidities.
Coronary ectasia patients with STEMI had higher rates of PCI failure and no-reflow than NE; however, mortality during follow-up was comparable.
冠状动脉扩张（CE）定义为冠状动脉内径扩张至周围血管的1.5倍。以ST段抬高型心肌梗死（STEMI）为表现的CE患者经皮冠状动脉介入治疗（PCI）的结果仍是一个有争议的话题。
检索比较CE与无扩张（NE）的STEMI患者PCI结果的研究。基线血管造影特征包括心肌梗死溶栓（TIMI）0-1级血流、右冠状动脉（RCA）受累情况，主要结局包括血栓抽吸、无复流、死亡率及PCI术后TIMI-3级血流。计算比值比（OR）和95%置信区间（CI）。
六项研究（n = 5746，CE组340例，NE组5406例）符合分析要求。RCA受累在CE组比NE组更常见，OR为1.39（95%CI 1.06-1.82，p = 0.02）。术前TIMI 0-1级血流在两组间结果相当（p = 1.13）。CE组血栓抽吸率更高（OR 2.18，95%CI 1.44-3.32；p < 0.001）。CE组无复流发生率更高（OR 4.07，95%CI 2.42-6.84；p < 0.001）。CE组PCI术后达到TIMI-3级血流的情况较少见（OR = 0.64，95%CI 0.48-0.86；p < 0.001）。随访期死亡率相当（0.83，95%CI 0.39-1.78；p = 0.63）。Meta回归分析未显示合并症的混杂效应。
与NE患者相比，STEMI合并CE的患者PCI失败率和无复流发生率更高；然而，随访期死亡率相当。
