Liu Ruifeng, Gao Xiangyu, Liang Siwen, Zhao Huiqiang
Department of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2022 Oct 11;9:950291. doi: 10.3389/fcvm.2022.950291. eCollection 2022.
Most of coronary artery ectasia (CAE) patients have comorbid coronary atherosclerosis. It was lack of prognostic data for CAE patients with coronary heart disease (CHD) and for whom with acute myocardial infarction (AMI).
To determine the overall prognosis for CAE patients.
This study was a retrospective cohort study. Fifty-one patients with CAE and comorbid AMI (CAE + AMI) and 108 patients with CAE and comorbid CHD (CAE + CHD) were enrolled and matched to non-CAE subjects at a ratio of 1:3 using a propensity score method, respectively. Controls for CAE + AMI group were 153 AMI patients, controls for CAE group were 324 CHD patients and 329 participants with relatively normal coronary arteries (CON). We followed them up to observe major cardiovascular events (MACE).
The Kaplan-Meier curves showed that the prognosis in CAE + AMI group was worse than in AMI group (5-year non-MACE rate: 62.70% vs. 79.70%, = 0.010), the prognosis in CAE group was worse than in CHD and CON groups (5-year non-MACE rate: 74.10% vs. 85.80% and 96.70%, respectively, = 0.000). The main MACEs in CAE + AMI and CAE groups were AMI reoccurrence (19.61% vs. 4.57%, = 0.002) and re-hospitalization due to repeated angina pectoris (14.81% vs. 8.33% and 2.74%, = 0.000), respectively. Additionally, the COX regression analysis revealed that the protective factors for preventing MACE in CAE + AMI group included antiplatelet agents (hazard ratio = 0.234, = 0.016) and angiotensin-converting enzyme inhibitor/angiotensin receptor inhibitor (ACEI/ARB, hazard ratio = 0.317, = 0.037). Whereas the main factor promoting MACE in CAE group was the degree of coronary stenosis (Gensini score, hazard ratio = 1.011, = 0.022).
The prognosis of patients with CAE + AMI was worse than that of those with AMI. The overall prognosis of patients with CAE was worse than that of those with CHD. CAE + AMI and CAE groups had different characteristics; the former was prone to AMI reoccurrence, and the latter was prone to repeated angina pectoris. To prevent MACE, medications, including antiplatelets and ACEI/ARBs, are indicated for patients with CAE + AMI, whereas prevention of the progression of atherosclerotic lesions is indicated for patients with CAE.
大多数冠状动脉扩张（CAE）患者合并冠状动脉粥样硬化。目前缺乏冠心病（CHD）合并CAE患者以及合并急性心肌梗死（AMI）的CAE患者的预后数据。
确定CAE患者的总体预后。
本研究为回顾性队列研究。纳入51例合并AMI的CAE患者（CAE+AMI）和108例合并CHD的CAE患者（CAE+CHD），并分别采用倾向评分法以1:3的比例与非CAE受试者进行匹配。CAE+AMI组的对照为153例AMI患者，CAE组的对照为324例CHD患者和329例冠状动脉相对正常的参与者（CON）。对他们进行随访以观察主要心血管事件（MACE）。
Kaplan-Meier曲线显示，CAE+AMI组的预后比AMI组差（5年无MACE发生率：62.70%对79.70%，P=0.010），CAE组的预后比CHD组和CON组差（5年无MACE发生率：分别为74.10%对85.80%和96.70%，P=0.000）。CAE+AMI组和CAE组的主要MACE分别是AMI复发（19.61%对4.57%，P=0.002）和因反复心绞痛再次住院（14.81%对8.33%和2.74%，P=0.000）。此外，COX回归分析显示，CAE+AMI组预防MACE的保护因素包括抗血小板药物（风险比=0.234，P=0.016）和血管紧张素转换酶抑制剂/血管紧张素受体抑制剂（ACEI/ARB，风险比=0.317，P=0.037）。而CAE组促进MACE的主要因素是冠状动脉狭窄程度（Gensini评分，风险比=1.011，P=0.022）。
CAE+AMI患者的预后比AMI患者差。CAE患者的总体预后比CHD患者差。CAE+AMI组和CAE组具有不同特征；前者易发生AMI复发，后者易发生反复心绞痛。为预防MACE，CAE+AMI患者应使用包括抗血小板药物和ACEI/ARB在内的药物，而CAE患者应预防动脉粥样硬化病变的进展。
