Diffuse coronary artery dilation predicted worse long-term outcomes in patients with coronary artery Ectasia

Background Coronary artery ectasia (CAE) is a rare finding in coronary angiography and associated with worse clinical outcomes. According to the extent of the dilated lesions, CAE is classified into diffuse and focal dilation. The difference in clinical outcomes between these 2 phenotypes remains unknown. Methods A cohort study was conducted comprising CAE patients identified by coronary angiography between January 2009 to December 2013. Follow-up was proceeded annually and the primary outcome was major adverse cardiovascular events (MACE) defined as a component of cardiovascular death and nonfatal myocardial infarction(MI). Kaplan-Meier method and Cox regression models were used to assess the clinical outcomes in diffuse CAE group and focal CAE group. Propensity score matching, propensity score weighting, and subgroup analysis were performed as sensitivity analysis. Results A total of 595 patients were included in this study, including 474 individuals with diffuse CAE and 121 with focal CAE. During a median follow-up of 87 months, Patients in diffuse CAE group showed significantly higher incidences of MACE (13.1% vs. 3.3%;HR 4.28, 95%CI 1.56–11.78, P = .005), as well as cardiovascular death (7.0% vs. 1.7%;HR 4.41, 95%CI 1.06–18.39, P = .041). Higher occurrence rate of MACE was consistent in propensity score matched cohort and propensity score weighted analysis. The same trend towards increased risk of MACE in diffuse CAE group was obtained among subgroup analysis. Conclusions Patients with diffuse CAE was associated with increased risk of MACE compared to those with focal CAE. Diffuse dilation found in coronary angiography should receive more attention by physicians.