Coronary Artery Ectasia Predicts Future Cardiac Events in Patients With Acute Myocardial Infarction.
OBJECTIVE
Coronary artery ectasia (CAE) is an infrequently observed vascular phenotype characterized by abnormal vessel dilatation and disturbed coronary flow, which potentially promote thrombogenicity and inflammatory reactions. However, whether or not CAE influences cardiovascular outcomes remains unknown.


APPROACH AND RESULTS
We investigated major adverse cardiac events (MACE; defined as cardiac death and nonfatal myocardial infarction [MI]) in 1698 patients with acute MI. The occurrence of MACE was compared in patients with and without CAE. CAE was identified in 3.0% of study subjects. During the 49-month observation period, CAE was associated with 3.25-, 2.71-, and 4.92-fold greater likelihoods of experiencing MACE (95% confidence interval [CI], 1.88-5.66; P<0.001), cardiac death (95% CI, 1.37-5.37; P=0.004), and nonfatal MI (95% CI, 2.20-11.0; P<0.001), respectively. These cardiac risks of CAE were consistently observed in a multivariate Cox proportional hazards model (MACE: hazard ratio, 4.94; 95% CI, 2.36-10.4; P<0.001) and in a propensity score-matched cohort (MACE: hazard ratio, 8.98; 95% CI, 1.14-71.0; P=0.03). Despite having a higher risk of CAE-related cardiac events, patients with CAE receiving anticoagulation therapy who achieved an optimal percent time in target therapeutic range, defined as ≥60%, did not experience the occurrence of MACE (P=0.03 versus patients with percent time in target therapeutic range <60% or without anticoagulation therapy).


CONCLUSIONS
The presence of CAE predicted future cardiac events in patients with acute MI. Our findings suggest that acute MI patients with CAE are a high-risk subset who might benefit from a pharmacological approach to controlling the coagulation cascade.
['Doi|Takahito|T|', 'Kataoka|Yu|Y|', 'Noguchi|Teruo|T|', 'Shibata|Tatsuhiro|T|', 'Nakashima|Takahiro|T|', 'Kawakami|Shoji|S|', 'Nakao|Kazuhiro|K|', 'Fujino|Masashi|M|', 'Nagai|Toshiyuki|T|', 'Kanaya|Tomoaki|T|', 'Tahara|Yoshio|Y|', 'Asaumi|Yasuhide|Y|', 'Tsuda|Etsuko|E|', 'Nakai|Michikazu|M|', 'Nishimura|Kunihiro|K|', 'Anzai|Toshihisa|T|', 'Kusano|Kengo|K|', 'Shimokawa|Hiroaki|H|', 'Goto|Yoichi|Y|', 'Yasuda|Satoshi|S|']
D000368:Aged D000369:Aged, 80 and over D000925:Anticoagulants D016009:Chi-Square Distribution D003323:Coronary Aneurysm D017023:Coronary Angiography D003326:Coronary Circulation D003331:Coronary Vessels D004108:Dilatation, Pathologic D005260:Female D006801:Humans D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors D053208:Kaplan-Meier Estimate D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D009203:Myocardial Infarction D062645:Percutaneous Coronary Intervention D011379:Prognosis D057216:Propensity Score D016016:Proportional Hazards Models D012008:Recurrence D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors
ectasia cardiac events myocardial infarction coronary artery disease propensity score