Abstract

Coronary ectasia presenting with acute coronary syndrome, its predictors and outcomes.

Author(s): Samir Rafla, Amr Zaki, Mohamed Sadaka, Elsayed Abdelaaty

Aim: The study aimed to assess the predictors and outcomes of coronary ectasia in patients presented with acute coronary syndromes. 

Methods: 280 patients met our inclusion and exclusion criteria as ectatic Coronary Artery Disease (CAE) presented with Acute Coronary Syndrome (ACS) (group 1), and another 280 random patients as a control group without coronary ectasia presented with ACS (group 2). CAE was defined as the dilatation of a coronary segment with a diameter 1.5 times higher than normal adjacent segments. PCI procedures are detailed in the paper. Follow-up was for one year in all and two years in half the patients. 

Results: CAE group 1 was compared to ACS. Patients without ectasia (group 2). Males were 93% vs. 71% in the two groups, respectively: hypertension (61% vs. 57%), dyslipidemia (21% vs. 28%), type 2 diabetes (26% vs. 36%), and ejection fraction more than 35% was present in 57 vs. 58%. Medical management only in 32% vs. 16% in the two groups. PCI was done in 42% vs. 76% in the two groups. CABG was done in 20 cases (7%) and 19 of the control group (7%).

Conclusion: The incidence of coronary ectasia is 4.9% among ACS patients. Mortality was 8.2% vs. 2.8% (P<0.005) in the two groups. Predictors of mortality: Male sex (0.010), previous ACS (0.021), and presentation with STEMI (0.018). Thrombus aspiration was done in 26% with no significant effect on hospital outcome. Most of the cases underwent balloon dilatation, 111 patients (94%), with no significant effect on hospital outcome.