Primary percutaneous coronary interventions in patients with acute coronary syndrome and coronary artery ectasia: angiographic and clinical outcomes

Coronary artery ectasia (CAE) is an uncommon finding (<2%) that may complicate the management of patients with acute coronary syndrome (ACS). Data on percutaneous coronary interventions (PCI) and outcomes in this population remain limited.

To evaluate angiographic and clinical outcomes in patients with ACS and CAE undergoing primary PCI, according to intervention type.

A retrospective cohort study was conducted including patients aged >18 years hospitalized in our center from 2012 to 2020 with ACS (both NSTEMI and STEMI), undergoing coronary angiography and presenting CAE. Baseline clinical characteristics, as well as interventional strategies (including stent placement, thromboaspiration, and GP IIb-IIIa use) were analyzed for their association with final flow TIMI ≥2. In addition, clinical outcomes were assessed using time-to-event analyses for recurrent infarction and major adverse cardiovascular events (MACE, defined as cardiovascular death, nonfatal infarction, or repeat revascularization). Kaplan–Meier curves were generated up to 1200 days across treatment groups and compared using global log-rank tests, and Cox proportional hazards models were fitted to estimate hazard ratios.

A total of 350 patients were included, of whom 67.8% had STEMI and 32.2% had NSTEMI. CAE was diffuse (Markis I) in 49.06% of patients. Any form of PCI was performed in 64.4%. Stent placement was strongly associated with achieving TIMI ≥2 (OR 9.72, 95% CI 4.26–22.21, p < 0.001). Use of GP IIb/IIIa inhibitors showed no significant association (OR 1.03, 95% CI 0.53–1.98, p = 0.94), and thromboaspiration trended toward lower odds (OR 0.49, 95% CI 0.20–1.17, p = 0.11). For clinical outcomes, global log-rank tests across the treatment groups revealed no significant differences in event-free survival for re-infarction or MACE. Unadjusted and adjusted Cox models confirmed the absence of statistically significant hazard ratio differences for any group, with wide confidence intervals reflecting limited power in smaller strata.

In ACS patients with CAE, stent placement is associated with improved post-PCI TIMI flow. However, this angiographic improvement did not translate into statistically significant differences in recurrent infarction or MACE, suggesting that TIMI restoration alone may not ensure better clinical outcomes in this population.

Intervention distribution by TIMI group