Prognostic significance, angiographic characteristics and impact of antithrombotic and anticoagulant therapy on outcomes in high versus low grade coronary artery ectasia: A long‐term follow‐up study

Abstract

OBJECTIVES: To assess the prognostic significance of high vs. low grade coronary artery ectasia (CAE) and the impact of antithrombotic or anticoagulant therapy on adverse cardiac outcomes. BACKGROUND: There is paucity of knowledge on the impact of angiographic characteristics in CAE or that of antithrombotic or anticoagulant therapy on outcomes. METHODS AND RESULTS: In this retrospective study, we reviewed angiograms and medical records of all cases of confirmed CAE (2001-2011). Extent of CAE was categorized using the Markis classification. Types 1 and 2 were categorized as high-grade and types 3 and 4 as low-grade CAE. Angiographic flow was recorded as normal or sluggish (<TIMI 3). Outcomes assessed were acute coronary syndromes and all-cause mortality on follow-up. The study included 317 patients with CAE (mean follow-up of 9.7 ± 2.3 years). High-grade CAE (n = 151) had a significantly higher incidence of ACS on follow-up (41% vs. 30%, P = 0.01; OR 2.0, CI 1.3-3.3, P = 0.01) despite similar underlying CAD. Sluggish coronary flow (irrespective of CAE grade) was also associated with a higher incidence of ACS (45% vs. 28%, P < 0.01; OR 2.25, CI 1.4-3.6, P = 0.01). Presence of both sluggish flow and high-grade CAE had an additive effect on occurrence of ACS (OR 4, CI 2.0-7.8, P < 0.01). Neither sluggish flow nor high-grade CAE were associated with mortality. Dual-antiplatelet therapy (DAPT) or use of oral anticoagulation was associated with a reduced incidence of ACS (17% vs. 34%, P = 0.03 and 29% vs. 42%, P = 0.02, respectively). CONCLUSION: The angiographic extent of CAE and sluggish coronary flow are independent predictors of future ACS despite good medical management. DAPT or oral anticoagulation reduces the risk of future ACS.