冠状动脉瘤的转归：来自冠状动脉扩张和动脉瘤注册研究（CAESAR）的见解。
Outcomes of coronary artery aneurysms: insights from the Coronary Artery Ectasia and Aneurysm Registry (CAESAR).
作者信息
Candreva Alessandro, Huwiler Jessica, Gallo Diego, Schweiger Victor, Gilhofer Thomas, Leone Roberta, Würdinger Michael, Lodi Rizzini Maurizio, Chiastra Claudio, Stehli Julia, Michel Jonathan, Gotschy Alexander, Stähli Barbara E, Ruschitzka Frank, Morbiducci Umberto, Templin Christian
机构信息
Department of Cardiology, Zurich University Hospital, Zurich, Switzerland.
PolitoBIO Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy.
出版信息
Swiss Med Wkly. 2025 Jan 6;155:3857. doi: 10.57187/s.3857.
BACKGROUND
Coronary artery ectasias and aneurysms (CAE/CAAs) are among the less common forms of coronary artery disease, with undefined long-term outcomes and treatment strategies.
AIMS
To assess the clinical characteristics, angiographic patterns, and long-term outcomes in patients with CAE, CAA, or both.
METHODS
This 15-year (2006-2021) retrospective single-centre registry included 281 patients diagnosed with CAE/CAA via invasive coronary angiography. Major adverse cardiovascular events included all-cause death, non-fatal myocardial infarction, unplanned ischaemia-driven revascularisation, hospitalisation for heart failure, cerebrovascular events, and clinically overt bleeding. Time-dependent event risks for the CAE and CAA groups were assessed using Cox regression models and Kaplan-Meier curves.
RESULTS
CAEs (n = 161, 57.3%) often had a multi-district distribution (45.8%), while CAAs (78, 27.8%) exhibited a single-vessel pattern (80%). The co-existence of CAAs and CAE was observed in 42 cases (14.9%), and multi-vessel obstructive coronary artery disease was prevalent (55.9% overall). Rates of major adverse cardiovascular events were 14.3% in-hospital and 38.1% at a median follow-up of 18.9 (interquartile range [IQR] 6.0-39.9) months. The presence of CAAs was associated with increased major adverse cardiovascular events risk in comparison to CAE (hazard ratio [HR] = 2.26, 95% confidence interval [CI] 1.38-3.69, p = 0.001), driven by a higher hazard ratio of non-fatal myocardial infarctions (HR = 5.00, 95% CI 1.66-15.0, p = 0.004) and unplanned ischaemia-driven revascularisation in both dilated (HR = 3.23, 95% CI 1.40-7.45, p = 0.006) and non-dilated coronary artery segments (HR 3.83, 95% CI 2.08-7.07, p = 0.001).
CONCLUSIONS
Overlap between obstructive and dilated coronary artery disease is frequent. Among the spectrum of dilated coronary artery disease, the presence of a CAA was associated with worse long-term outcomes.
背景
冠状动脉扩张和动脉瘤（CAE/CAA）是冠状动脉疾病中较不常见的形式，其长期预后和治疗策略尚不明确。
目的
评估CAE、CAA或两者并存患者的临床特征、血管造影模式和长期预后。
方法
这项为期15年（2006 - 2021年）的回顾性单中心登记研究纳入了281例经有创冠状动脉造影诊断为CAE/CAA的患者。主要不良心血管事件包括全因死亡、非致命性心肌梗死、非计划性缺血驱动的血运重建、因心力衰竭住院、脑血管事件和临床明显出血。使用Cox回归模型和Kaplan-Meier曲线评估CAE组和CAA组的时间依赖性事件风险。
结果
CAE（n = 161，57.3%）常呈多节段分布（45.8%），而CAA（78例，27.8%）表现为单支血管模式（80%）。42例（14.9%）患者同时存在CAA和CAE，多支血管阻塞性冠状动脉疾病较为普遍（总体为55.9%）。主要不良心血管事件的发生率在住院期间为14.3%，在中位随访18.9（四分位间距[IQR] 6.0 - 39.9）个月时为38.1%。与CAE相比，CAA的存在与主要不良心血管事件风险增加相关（风险比[HR] = 2.26，95%置信区间[CI] 1.38 - 3.69，p = 0.001），这是由非致命性心肌梗死（HR = 5.00，95% CI 1.66 - 15.0，p = 0.004）以及扩张和未扩张冠状动脉节段中非计划性缺血驱动的血运重建的较高风险比（扩张节段HR = 3.23，95% CI 1.40 - 7.45，p = 0.006；未扩张节段HR = 3.83，95% CI 2.08 - 7.07，p = 0.001）所驱动。
结论
阻塞性和扩张性冠状动脉疾病之间的重叠很常见。在扩张性冠状动脉疾病范围内，CAA的存在与更差的长期预后相关。
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