Percutaneous coronary intervention and risk of major adverse cardiovascular events in patients with coronary artery ectasia and acute coronary syndrome

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Coronary artery ectasia (CAE) is defined as segmental or diffuse dilation of a coronary artery with a diameter of at least 1.5 times the normal adjacent segment, affecting more than one-third of the length of the artery. It has been described as a relatively infrequent finding with a prevalence from 0.3% to 5%, however, in our population we have previously found it higher, up to 6.7%.

In patients with STEMI and ectatic infarct-related artery (EIRA), performing percutaneous coronary intervention (PCI) has been reported to provide better in-hospital outcomes (3), but long-term prognosis remains controversial, with a high mortality risk and cardiovascular events after PCI.

No standard approach has been defined for interventional treatment in the acute setting. High thrombus burden and coronary dilation make interventional treatment more challenging.

The aim of the present study was to assess the rate of MACE in the long-term according to the use of PCI in patients with CAE and ACS.

This was a retrospective analysis of a randomized controlled trial (OVERTIME NCT). Sixty-two consecutive patients with ACS (STEMI or NSTEMI) in whom coronary angiography demonstrated CAE were included.

The mean age of the 62 patients was 55.7+/- 10.6 years. Of them, 12.9% were women and 87.1% were men. The most common presentation was STEMI in 52 patients (83.8%) and 10 patients (19.2%) presented with NSTEMI. After coronary angiography, 48.4% received PCI and 51.6% did not. Baseline clinical characteristics were not different between groups.

During follow up, 8 patients (12.9%) presented a MACE. We found that the risk of MACE was not statistically different, by PCI use (HR 0.67, 95% CI 0.16-2.84, p = 0.5) (Figure 1). We also analyzed the intracoronary use of glycoprotein IIb/IIIa inhibitors, with no long-term differences between groups.

In patients with CAE and ACS, we found non-statistically significant differences in the risk of MACE between patients who were treated with PCI compared to those without PCI.