Risk factors and outcomes in patients with coronary artery aneurysms

doi:10.1016/j.amjcard.2004.03.011

The American Journal of Cardiology

Volume 93, Issue 12, 15 June 2004, Pages 1549-1551

https://doi.org/10.1016/j.amjcard.2004.03.011 Get rights and content

Abstract

Previous small series have provided conflicting data on the association between coronary artery aneurysms and traditional cardiac risk factors, as well as limited information on patient outcomes. This investigation sought to determine whether the presence of coronary artery aneurysms has an adverse affect on patient outcomes. The results show that coronary aneurysms were an independent predictor of mortality, and overall 5-year survival in patients with aneurysms was only 71%. We believe that clinicians should aggressively monitor and modify coronary risk factors in patients with coronary aneurysms.

Section snippets

Acknowledgments

The investigators thank Debbie Canup, BFA, and Dee Anderson, BFA, from the Emory Cardiac Databank for their assistance in the maintenance and follow-up of the data for this study.

References (6)

J.E Markis et al.
Clinical significance of coronary arterial ectasia
Am J Cardiol
(1976)
E.L Kaplan et al.
Nonparametric estimation from incomplete observations
J Am Stat Assoc
(1958)
D.R Cox
Regression models and life tables
J R Stat Soc
(1972)

There are more references available in the full text version of this article.

Cited by (159)

In-hospital outcomes and conditions in patients with acute coronary syndrome and coronary artery aneurysms who undergo percutaneous coronary intervention
2023, Cardiovascular Revascularization Medicine
Coronary artery aneurysms (CAA) are uncommon, often incidental findings in patients with acute coronary syndrome (ACS) that represent a management challenge due to as there is a paucity of literature in this area.
We analyzed the National Inpatient Sample database from 2016 to 2020 by including all patients with the admission diagnosis of the ACS who underwent percutaneous coronary intervention (PCI). We sought to evaluate the association of CAA with other relevant systemic conditions and determine the impact of CAA on in-hospital outcomes.
Among 1,733,655 hospital admission with ACS who underwent PCI, 2675 had CAA. There was a 2-fold increase in odds of CAA if the patient had coronary artery dissection (OR 2.05 95%CI 1.12–3.75, p = 0.020) or extracoronary aneurysm (OR 2.47 95%CI 1.46–4.16, p = 0.001) and a 3-fold increase in odds if they had a systematic inflammatory disorder (OR 3.24 95%CI 2.08–5.07, p < 0.001). CAA was not associated with increased odds of mortality (OR 1.22 95%CI 0.76–1.95, p = 0.42), bleeding (OR 1.29 95%CI 0.86–1.95, p = 0.22), acute stroke (OR 0.91 95%CI 0.40–2.07, p = 0.83), major adverse cardiac and cerebrovascular events (OR 1.08 95%CI 0.72–1.61, p = 0.71) or cardiac complications (OR 0.85 95%CI 0.49–1.47, p = 0.55). However, it was significantly associated with increased odds of vascular complications (OR 2.17 95%CI 1.47–3.19, p < 0.001).
For patients with ACS who undergo PCI, the presence of CAA is associated with greater odds of vascular complications but after adjustments there was no difference in mortality or other complications. In this population, CAA is more prevalent in patients with coronary dissection, extracoronary aneurysms and systemic inflammatory disorders.
Perioperative Management of Giant Coronary Artery Aneurysm
2023, Journal of Cardiothoracic and Vascular Anesthesia
Incidental Finding of a Giant Left Main Coronary Artery Aneurysm as an Anterior Mediastinal Mass
2023, Heart Lung and Circulation
In-Hospital Outcomes and Conditions Associated With Coronary Artery Aneurysms in Chronic Coronary Syndrome
2023, Cardiovascular Revascularization Medicine
Coronary artery aneurysms (CAA) are infrequent findings among patients undergoing coronary angiography and may be associated with systemic diseases.
We analyzed the National Inpatient Sample database from 2016 to 2020 by including all patients with the admission diagnosis of the chronic coronary syndrome (CCS). We sought to determine the impact of CAA on in-hospital outcomes encompassing all-cause death, bleeding, cardiovascular complications, and stroke. Secondly, we examined the association of CAA with other relevant systemic conditions.
The presence of CAA was associated with a 3-fold increase in the odds of cardiovascular complications (OR 3.1, 95 % CI 2.9–3.8), however, it was associated with reduced odds of stroke (OR 0.7, 95 % CI 0.6–0.9). There was no significant impact on all-cause death and overall bleeding complications, although there appeared to be a reduction in the odds of gastrointestinal (GI) bleeding associated with CAA (OR 0.6, 95 % CI 0.4–0.8). Patients with CAA vs. those without CAA had a significantly greater prevalence of extracoronary arterial aneurysms (7.9 % vs. 1.4 %), systemic inflammatory disorders (6.5 % vs. 1.1 %), connective tissue disease (1.6 % vs. 0.6 %), coronary artery dissection (1.3 % vs. 0.1 %), bicuspid aortic valve (0.8 % vs. 0.2 %), and extracoronary arterial dissection (0.3 % vs. 0.1 %). In the multivariable regression, systemic inflammatory disorders, extracoronary aneurysms, coronary artery dissection, and connective tissue diseases were independent predictors of CAA.
CAA in patients with CCS is associated with greater odds of cardiovascular complications during hospitalization. These patients also had a substantially greater prevalence of extracardiac vascular and systemic abnormalities.
Coronary artery fistula with or without aneurysm: A large comparative study
2023, Heliyon
The knowledge of coronary artery fistula (CAF) with coronary aneurysm mostly comes from case reports and is very limited. However, the management of CAF with and without aneurysm is different, more understanding of its clinical and imaging features is necessary. This is the first research focus on it through a large comparative study.
To investigate the differences in imaging and clinical features of CAF with and without aneurysms.
We reviewed 96,037 consecutive patients undergoing coronary computed tomography angiogram (CCTA) between 2016 and 2020 and total of 429 CAF adult patients were enrolled. Those patients were divided into the CAF with aneurysm group (321 cases, 74.83%) and CAF without aneurysm group (108 cases, 25.17%) according to whether complicated with coronary aneurysm. Clinical baseline data, electrocardiographic (ECG) characteristics, the presence or absence of coronary atherosclerosis, complication symptoms and fistulous origin, entry site, number and diameter were analyzed. Chi-square test, T-test, Mann-Whitney U tests, and logistic regression analysis were performed.
Most of the clinical baseline data did not differ significantly between the two groups (P > 0.05). However, heart murmur, coronary atherosclerosis, infective endocarditis (IE), fistulous diameter and fistulous entry site were significantly different (P＜0.05). Further multivariate logistic regression analysis showed that large fistulous diameter and coronary-cardiac chamber arterial fistulas was dependent risk factors for CAF complicated with aneurysm.
CAF patients with aneurysm were more prone to develop heart murmur than those patients without aneurysm. Different from other sites of aneurysms, coronary atherosclerosis is more common in CAF without aneurysm. Larger fistulous diameter and coronary-cardiac chamber arterial fistula are dependent risk factors for CAF with aneurysms.
Coronary Artery Aneurysms: Comprehensive Review and a Case Report of a Left Main Coronary Artery Aneurysm
2023, Current Problems in Cardiology
Coronary artery aneurysms (CAAs) are rare anatomical disorders of the coronary arteries. Atherosclerosis and Kawasaki disease are the principal causes of CCAs, while other causes including genetic factors, inflammatory arterial diseases, connective tissue disorders, endothelial damage after cocaine use, iatrogenic complications after interventions and infections, are also common among patients with CAAs. Although there is a variety of noninvasive methods including echocardiography, computed tomography, and magnetic resonance imaging, coronary angiography remains the gold standard diagnostic method. There is still no consensus about the most appropriate therapeutic strategy. Medical therapy including antiplatelets, anticoagulants, statins and ACEs are preferred either in patients with atherosclerosis, inflammatory status and stable CAAs, while percutaneous or surgery interventions are usually applied in patients with acute coronary syndrome due to a CAA culprit, obstructive coronary artery disease or large saccular aneurysms at a high risk of rupturing.

View all citing articles on Scopus

View full text

Infection and Malignancy in Rheumatic Diseases
Rheumatic Disease Clinics of North America, Volume 43, Issue 1, 2017, pp. xi-xii
Michael H. Weisman
Bilateral Versus Single Internal Mammary Artery Grafting in the Elderly: Long-Term Survival Benefit
The Annals of Thoracic Surgery, Volume 100, Issue 4, 2015, pp. 1374-1382
Paul A. Kurlansky, …, George Ebra
Infected (“Mycotic”) coronary artery aneurysm: Systematic review
Journal of Cardiovascular Computed Tomography, Volume 14, Issue 6, 2020, pp. e99-e104
Carlos S. Restrepo, …, Carlos A. Rojas
Ectasies coronaires et thrombus
Annales de Cardiologie et d'Angéiologie, Volume 66, Issue 6, 2017, pp. 425-432
M.A. Bouzid, …, X. Halna du Fretay
Detection of spontaneous coronary artery spasm with optical coherence tomography in a patient with acute coronary syndrome
Cardiovascular Revascularization Medicine, Volume 18, Issue 6, Supplement 1, 2017, pp. 7-9
HanyTawfik Fathelbab, …, José Francisco Díaz Fernández
Editorial: Coronary artery aneurysms in chronic coronary syndromes
Cardiovascular Revascularization Medicine, Volume 54, 2023, pp. 14-15
Nauman Khalid, Sarah Aftab Ahmad

Risk factors and outcomes in patients with coronary artery aneurysms

Abstract

Section snippets

Acknowledgments

Am J Cardiol

Nonparametric estimation from incomplete observations

J Am Stat Assoc

Regression models and life tables

J R Stat Soc