Is Anticoagulant Necessary in Patients with Coronary Artery Ectasia Presenting with Acute Coronary Syndrome? A Systematic Review of Case Reports

AbstractCoronary artery ectasia is found in 3 to 8% of patient's undergoing angiography and may sometimes induce acute myocardial infarction. Some articles reported a recurrence of acute coronary syndrome (ACS) in the presence of coronary artery ectasia (CAE). Our study aims to summarize the latest evidence on whether the use of anticoagulant in addition to SAPT/DAPT (single antiplatelet/dual antiplatelet) treating ACS with CAE patients is necessary. Since the trials concerning our objectives were scarce, we pooled case reports/series. We performed a comprehensive search on case reports/series on coronary artery ectasia that presented with acute coronary syndrome published until March 2019. We collected 13 cases from 11 reports. Out of 13 patients, 5 (38.5%) took DAPT only without anticoagulant and 8 (61.5%) took anticoagulant ± DAPT. Three out of five (60%) who took DAPT only, experienced recurrences at 1st and 2nd months' follow-up. The other two (40%) was uneventful at a mean of two months' follow-up. Eight patients who took anticoagulant were uneventful for a mean of 8.4 months. Those who took anticoagulant were at lower risk of experiencing ACS recurrence (p = 0.035). Two of the patients who experienced recurrence became 6 and 12 months free after optimal anticoagulation. The author of this study proposed that anticoagulant must be considered should SAPT/DAPT failed to provide adequate protection to the recurrence of ACS, especially in CAE patients who did not have other obvious stenotic lesions. However, the evidence is weak since this study only pooled case reports/series.

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A pebble clogging a river: a case report of thrombosed coronary aneurysmal ectasia

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa274 ◽

2020 ◽

Author(s):

Akshar Jaglan ◽

Tarek Ajam ◽

Steven C Port ◽

Tanvir Bajwa ◽

A Jamil Tajik

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Kawasaki Disease ◽

Treatment Options ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Coronary Artery Ectasia ◽

Ventricular Ejection Fraction ◽

Coronary Syndrome ◽

Patient Reported

Abstract Background Coronary artery ectasia (CAE) is a rare anomaly that can present at any age. Predisposing risk factors include Kawasaki disease in a younger population and atherosclerosis in the older generation. We present a unique case of the management of a young woman diagnosed with multivessel CAE with aneurysmal changes in the setting of acute coronary syndrome and subsequently during pregnancy. Case summary A 23-year-old woman presented with acute onset chest pain. Electrocardiogram revealed no ischaemic changes; however, troponin I peaked at 16 ng/mL (reference range 0–0.04 ng/mL). Echocardiogram showed apical dyskinesis with preserved left ventricular ejection fraction. Coronary angiography showed multivessel CAE along with significant thrombus burden in an ectatic lesion of the left anterior descending artery. Since the patient was haemodynamically stable, conservative management with dual antiplatelet therapy and anticoagulation was started. On follow-up, coronary computed tomographic angiogram illustrated resolution of the coronary thrombi and echocardiogram showed improvement to the apical dyskinesis. It was presumed that Kawasaki disease was the most likely aetiology of her disease. Subsequently the patient reported that, contrary to medical advice, she was pregnant, adding another layer of complexity to her case. Discussion Coronary artery ectasia can be discovered as an incidental finding or can present with an acute coronary syndrome. Management is challenging in the absence of randomized trials and large-scale data. Treatment options include medications, percutaneous intervention, and surgical revascularization. Close surveillance is required in these patients to assess progression of disease. Here we discuss treatment options during acute coronary syndrome and pregnancy.

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Coronary artery aneurysm presenting as acute coronary syndrome: two case reports and a review of the literature

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-021-02418-2 ◽

2021 ◽

Author(s):

Tuncay Taskesen ◽

Kofi Osei ◽

Justin Ugwu ◽

Russell Hamilton ◽

Mark Tannenbaum ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Coronary Artery Aneurysm ◽

Case Reports ◽

Artery Aneurysm ◽

Review Of The Literature ◽

Coronary Syndrome

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IMMEDIATE AND 4-YEAR OUTCOME OF PATIENTS WITH ACUTE CORONARY SYNDROME UNDERGOING PERCUTANEOUS CORONARY INTERVENTION FOR LEFT MAIN CORONARY ARTERY DISEASE

10.36106/gjra/4600459 ◽

2021 ◽

pp. 8-11

Author(s):

Saroj Mandal ◽

Sidnath Singh ◽

Kaushik Banerjee ◽

Aditya Verma ◽

Vignesh R.

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Ejection Fraction ◽

Coronary Intervention ◽

Left Ventricular Ejection ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

The Mean

Background: The treatment of LMCAD has shifted from coronary artery bypass grafting (CABG) to Percutaneous coronary intervention (PCI). However, data on long-term outcomes of PCI for LMCA disease, especially in patients with acute coronary syndrome (ACS) remains limited and conicting. This study aims to nd the association of the immediate and 4-year mortality in ACS patients with LMCA disease treated by PCI based on ejection fractions at admission. Methods: A retrospective analytical study was conducted. Patients were divided at admission into those with reduced left ventricular ejection fraction and those with preserved ejection fraction. Results: Forty (58.8%) of the patients presented with preserved EF. The mean age of the patients was 71.6±7.1 years. The mean LVEF of the preserved group was 61.6±4.3% and signicantly higher than that of the reduced group. Age and cardiovascular risk factor prole was similar between the two groups. Patients with reduced ejection fraction had signicantly higher levels of serum creatinine and signicantly lower levels of Hb and HDL. Mean hospital stay was signicantly longer for patients with preserved EF. In-hospital deaths were also similar between the two groups. The reduced EF group had a signicantly higher allcause mortality in the 4-year follow-up period. The mean years of follow-up for all participants was 4.2±1.3 years. Conclusion: It was seen that in patients presenting with ACS and undergoing PCI due to LMCAD, LVEF at admission, singly and in in multivariate regression is an important predictor of in hospital and 4-year mortality

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Monocyte Chemoattractant Protein-1 Is an Independent Predictor of Coronary Artery Ectasia in Patients with Acute Coronary Syndrome

Journal of Clinical Medicine ◽

10.3390/jcm9093037 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3037

Author(s):

Juan Antonio Franco-Peláez ◽

Roberto Martín-Reyes ◽

Ana María Pello-Lázaro ◽

Álvaro Aceña ◽

Óscar Lorenzo ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Independent Predictor ◽

Mineral Metabolism ◽

Binary Logistic Regression Analysis ◽

Coronary Artery Ectasia ◽

Monocyte Chemoattractant Protein 1 ◽

Monocyte Chemoattractant ◽

Coronary Syndrome ◽

Monocyte Chemoattractant Protein

Our purpose was to assess a possible association of inflammatory, lipid and mineral metabolism biomarkers with coronary artery ectasia (CAE) and to determine a possible association of this with acute atherotrombotic events (AAT). We studied 270 patients who underwent coronary angiography during an acute coronary syndrome 6 months before. Plasma levels of several biomarkers were assessed, and patients were followed during a median of 5.35 (3.88–6.65) years. Two interventional cardiologists reviewed the coronary angiograms, diagnosing CAE according to previously published criteria in 23 patients (8.5%). Multivariate binary logistic regression analysis was used to search for independent predictors of CAE. Multivariate analysis revealed that, aside from gender and a diagnosis of dyslipidemia, only monocyte chemoattractant protein-1 (MCP-1) (OR = 2.25, 95%CI = (1.35–3.76) for each increase of 100 pg/mL, p = 0.001) was independent predictor of CAE, whereas mineral metabolism markers or proprotein convertase subtilisin/kexin type 9 were not. Moreover, CAE was a strong predictor of AAT during follow-up after adjustment for other clinically relevant variables (HR = 2.67, 95%CI = (1.22–5.82), p = 0.013). This is the first report showing that MCP-1 is an independent predictor of CAE, suggesting that CAE and coronary artery disease may share pathogenic mechanisms. Furthermore, CAE was associated with an increased incidence of AAT.

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Differential effects of dual antiplatelet therapy in patients presented with acute coronary syndrome vs. stable ischaemic heart disease after coronary artery bypass grafting

European Heart Journal - Cardiovascular Pharmacotherapy ◽

10.1093/ehjcvp/pvaa080 ◽

2020 ◽

Author(s):

Ki Hong Choi ◽

Young Bin Song ◽

Dong Seop Jeong ◽

Yong Ho Jang ◽

David Hong ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Heart Disease ◽

Coronary Artery ◽

Antiplatelet Therapy ◽

Lower Risk ◽

Dual Antiplatelet Therapy ◽

Artery Bypass ◽

Cardiovascular Death ◽

Bypass Grafting ◽

Coronary Syndrome

Abstract Aims The current study sought to evaluate whether long-term clinical outcomes according to the use of dual antiplatelet therapy (DAPT) or single antiplatelet therapy (SAPT) differed between acute coronary syndrome (ACS) and stable ischaemic heart disease (SIHD) patients who underwent coronary artery bypass grafting surgery (CABG). Methods and results Between January 2001 and December 2017, 3199 patients with ACS (55.3%) and 2583 with SIHD (44.7%) who underwent isolated CABG were enrolled. The study population was stratified using DAPT or SAPT in ACS patients and SIHD patients. The primary outcome was a cardiovascular death or myocardial infarction (MI) at 5 years. After CABG, DAPT was more frequently used in patients with ACS than in those with SIHD [n = 1960 (61.3%) vs. n = 1313 (50.8%), P < 0.001]. Among patients with ACS, the DAPT group showed a significantly lower risk of cardiovascular death or MI at 5 years than the SAPT group [DAPT vs. SAPT, 4.0% vs. 7.8%, hazard ratio (HR) 0.521, 95% confidence interval (CI) 0.339–0.799; P = 0.003]. In contrast, among patients with SIHD, there was no significant difference in the rate of cardiovascular death or MI at 5 years between the use of DAPT and SAPT (4.0% vs. 4.0%, HR 0.991, 95% CI 0.604–1.626; P = 0.971). These findings were robust to multiple sensitivity analyses and competing risk analysis. In the subgroup analysis, the use of DAPT was associated with a significantly lower risk of cardiovascular death or MI among SIHD patients with a previous percutaneous coronary intervention (PCI), with a significant interaction between the use of DAPT and PCI history (interaction P = 0.011). Conclusion Among ACS patients who underwent CABG, the use of DAPT was associated with lower cardiovascular death or MI than the use of SAPT, but this was not the case in SIHD patients. Trial registration ClinicalTrials.gov, NCT03870815.

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Recurrent acute coronary syndrome in a patient with right coronary artery ectasia: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-019-1979-x ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 3

Author(s):

Vito Damay ◽

Raymond Pranata ◽

Wendy Wiharja

Keyword(s):

Acute Coronary Syndrome ◽

Case Report ◽

Coronary Artery ◽

Right Coronary Artery ◽

Coronary Artery Ectasia ◽

Coronary Syndrome

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TCTAP C-029 Stand-alone Thrombus Aspiration in Acute Coronary Syndrome Due to Coronary Artery Ectasia

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2016.03.232 ◽

2016 ◽

Vol 67 (16) ◽

pp. S108-S110

Author(s):

Hendro Adi Kuncoro ◽

Soetandar Widjaja ◽

Iman Suhartono ◽

Andreas Sumargo ◽

Johan Senihardja ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Coronary Artery Ectasia ◽

Thrombus Aspiration ◽

Coronary Syndrome

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Long-term results of different approaches to revascularization in non-ST-segment elevation acute coronary syndrome and multiple coronary atherosclerosis

Terapevticheskii arkhiv ◽

10.17116/terarkh201789429-34 ◽

2017 ◽

Vol 89 (4) ◽

pp. 29-34 ◽

Cited By ~ 1

Author(s):

V I Ganyukov ◽

R S Tarasov ◽

Yu N Neverova ◽

N A Kochergin ◽

O L Barbarash ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Medical Treatment ◽

Coronary Atherosclerosis ◽

Long Term Results ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment

Aim. To assess the long-term results of different approaches to treating patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) and multivessel coronary artery disease (MVCAD). Subjects and methods. A total of 150 patients with NSTE ACS, in whom coronary angiography revealed MVCAD, were examined. The patients were divided into 3 groups according to the selected treatment policy: 1) percutaneous coronary intervention (PCI) (n=91 (60.6%)); 2) coronary artery bypass grafting (CABG) (n=40 (26.6%)); and 3) only medical treatment (n=9 (6%)). The mean follow-up was 27.6±3.5 months. Results. The medical treatment policy in this patient sample demonstrates the worst results, with the majority of cardiovascular events developing in the hospital period. PCI in patients with NSTE ACS and multiple coronary atherosclerosis has a number of objective limitations in this patient sample, leading to suboptimal treatment outcomes Conclusion. The use of CABG or PCI as a myocardial revascularization technique in patients with NSTE ACS and MVCAD is characterized by a comparable satisfactory survival in the hospital and long-term follow-up periods. 12% of patients do not receive revascularization due to the extremely high risk from any of coronary blood restoring methods, which results in very many deaths largely occurring during the hospital period.

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