Mellat Park, Vali Asr Avenue, Tehran, Iran
Background- Coronary artery ectasia (CAE) is considered an accompaniment or variant of coronary atherosclerosis. The contribution of CAE, either isolated or in association with obstructive coronary artery disease, to morbidity and mortality from ischemic heart disease is not well defined.
Methods and Results- To study the clinical and historical features and the natural history of CAE, the epidemiological, clinical, angiographic, and follow-up characteristics of three groups of patients were examined: Group A, 72 patients with CAE and coexisting coronary artery disease (CAD); group B, 45 patients with CAE only; group C, 153 patients with significant CAD but without ectasia, matched for sex, age and risk factors with group A.
Group A had a similar incidence of an old myocardial infarction (MI) to group C (75% vs. 77%), exercise tolerance, severity of stenotic lesions (CASS score 2.2 vs. 2.18), and similar involvement and distribution of diseased vessels. At follow up of two years, they had a similar incidence of unstable angina (6.8% vs. 4.4%) and MI plus cardiac death (5.1% vs. 6.2%). They underwent coronary bypass surgery with similar frequency (40% vs. 43%) but a lower frequency of coronary angioplasty (5.7% vs. 16.8%). Patients with pure CAE (group B) had a lower incidence of MI (25%, p<0.05) than the two other groups. The infarct was related to an ectatic coronary artery. Their exercise tolerance and ejection fraction were higher than those in groups A and C. Group B had no MI, cardiac death, surgery, or intervention at follow-up, but 5.8% of these patients developed unstable angina.
Conclusions- CAE does not confer risk in patients with coexisting stenotic CAD. In spite of a history of previous MI, patients with pure CAE have a good prognosis.