Adult isolated coronary artery ectasia: clinical features and long-term outcomes

TL;DR

This study examines the long-term outcomes of a rare heart condition called adult isolated coronary artery ectasia, finding a higher risk of major cardiovascular events compared to healthy individuals.

Contribution

The study provides new insights into the clinical features and long-term risks of adult isolated coronary artery ectasia.

Findings

ICAE patients had a higher risk of major adverse cardiovascular events compared to controls.

ICAE was associated with hypertension, abnormal ECGs, and elevated cardiac biomarkers.

Multivessel involvement and slow coronary flow were common in ICAE patients.

Abstract

Adult isolated coronary artery ectasia (ICAE) is a rare disease characterized by dilation of coronary arteries in the absence of significant stenosis. Its long-term prognosis and optimal management remain unclear. This study aimed to investigate the clinical and long-term outcomes of adult ICAE compared to controls with normal coronary arteries.

This retrospective analysis utilized prospectively maintained coronary angiography databases at Guangdong Provincial People's Hospital (2012–2022). ICAE was defined as ≥1.5 times dilation with <20% stenosis. Adult patients meeting these criteria, after excluding cases with significant stenosis or secondary causes, were matched 1:1 by age and sex to controls with normal coronary arteries. Clinical, laboratory, ECG, echocardiographic, and angiographic data were collected. The primary outcome was all-cause mortality, and the secondary outcome was major adverse cardiovascular events (MACE).

The study included 171 adult ICAE patients and 171 matched controls. Compared to controls, ICAE patients exhibited a higher prevalence of hypertension, elevated cardiac biomarkers, and more frequent ECG abnormalities. Angiography showed a predilection for the LAD (70.8%) and frequent multivessel involvement; slow flow was noted in 26.9%. After a median 6.2-year follow-up, ICAE patients had a significantly increased risk of MACE (HR 2.17, 95% CI 1.23–3.82, p = 0.006), while all-cause mortality was similar (HR 1.07, 95% CI 0.43–2.63, p = 0.886).

Adult ICAE exhibits distinct clinical and angiographic features, consistent with a chronic ischemia–like phenotype and possible association with elevated MACE risk.

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