Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut, Egypt.
Int J Cardiol. 2024 Nov 1;414:132412. doi: 10.1016/j.ijcard.2024.132412. Epub 2024 Jul 30.
Treatment of isolated and non-obstructive atherosclerotic coronary artery ectasia (CAE) is still controversial.
To assess the efficacy and safety of vitamin-K antagonist (VKA) versus dual antiplatelet (DAPT) therapy in management of patients with isolated and non-obstructive atherosclerotic CAE.
We prospectively enrolled 79 patients diagnosed on elective coronary angiography to have either isolated CAE or non-obstructive atherosclerotic CAE. Patients were assigned in 1:1 pattern to receive either VKA (warfarin) or DAPT (aspirin plus clopidogrel). Patients were followed-up for nine-months. The primary endpoint was the cumulative events rate including acute coronary event, target vessel intervention, or cardiac death. Analysis of cumulative events at different time intervals, its individual components, and bleeding were considered secondary endpoints.
Cumulative events rate was 33%, with mortality rate of 2.5%. Both treatment groups showed comparable cumulative events during the nine-months follow-up duration. Nevertheless, Kaplan-Meier analysis beyond the first 3-months of follow-up showed significantly higher event-free survival among the VKA-group. Recurrent events (≥2) were significantly higher among the DAPT-group. Both groups showed no major bleeding events. Multivariable cox-regression analysis showed that presence of significant coronary tortuosity, use of DAPT in reference to VKA, and lower percent time in therapeutic range (%TTR) among those receiving VKA were significant independent predictors of clinical adverse events beyond the first 3-months of follow-up.
Cumulative adverse events were comparable among both treatment groups for isolated non-obstructive CAE. However, adverse events were significantly more frequent in the DAPT-group beyond the first three months.
孤立性非阻塞性动脉粥样硬化性冠状动脉扩张症（CAE）的治疗仍存在争议。
评估维生素 K 拮抗剂（VKA）与双联抗血小板（DAPT）治疗在孤立性非阻塞性动脉粥样硬化性 CAE 患者管理中的疗效和安全性。
我们前瞻性纳入 79 例在选择性冠状动脉造影中诊断为孤立性 CAE 或非阻塞性动脉粥样硬化性 CAE 的患者。患者以 1:1 的比例随机分配接受 VKA（华法林）或 DAPT（阿司匹林加氯吡格雷）治疗。患者随访 9 个月。主要终点是包括急性冠状动脉事件、靶血管介入或心脏死亡的累积事件发生率。分析不同时间间隔的累积事件及其各个组成部分和出血情况被认为是次要终点。
累积事件发生率为 33%，死亡率为 2.5%。两组在 9 个月的随访期间累积事件发生率相当。然而，随访 3 个月后的 Kaplan-Meier 分析显示，VKA 组的无事件生存率显著更高。DAPT 组的复发性事件（≥2）显著更高。两组均无主要出血事件。多变量 Cox 回归分析显示，存在显著的冠状动脉扭曲、与 VKA 相比使用 DAPT 以及接受 VKA 治疗时的治疗时间百分比（%TTR）较低是随访 3 个月后发生临床不良事件的独立预测因素。
在孤立性非阻塞性 CAE 患者中，两种治疗方法的累积不良事件相当。然而，DAPT 组在随访 3 个月后不良事件明显更频繁。
