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

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.