Coronary artery aneurysms, insights from the international coronary artery aneurysm registry (CAAR)
Iván J Núñez-Gil, Enrico Cerrato, Mario Bollati, Luis Nombela-Franco, Belén Terol, Emilio Alfonso-Rodríguez, Santiago J Camacho Freire, Pedro A Villablanca, Ignacio J Amat Santos, José M de la Torre Hernández, Isaac Pascual, Christoph Liebetrau, Benjamín Camacho, Marco Pavani, Juan Albistur, Roberto Adriano Latini, Ferdinando Varbella, Víctor Alfonso Jiménez-Díaz, Davide Piraino, Massimo Mancone, Fernando Alfonso, José Antonio Linares, Ramón Rodríguez-Olivares, Jesús M Jiménez Mazuecos, Jorge Palazuelos Molinero, Alejandro Sánchez-Grande Flecha, Joan Antoni Gomez-Hospital, Alfonso Ielasi, Íñigo Lozano, Pierluigi Omedè, Rodrigo Bagur, Fabrizio Ugo, Massimo Medda, Boshra F Louka, Petr Kala, Javier Escaned, Daniel Bautista, Gisela Feltes, Pablo Salinas, Mohamad Alkhouli, Carlos Macaya, Antonio Fernández-Ortiz, CAAR investigators, Piter Martínez Benítez, Antonio Gomez Menchero, Javier León Jimenez, José Francisco Díaz Fernandez, Mohammed Makkiya, Nurilign Bulcha, Sarabjeet Suri, Paol Rojas, Tamara Garcia Camarero, Pablo Avanzas, Cesar Morís, Christoph Berndt, Pedro Trujillo, Gustavo Vignolo, Rafael Mila, Dario Buccheri, Pedro Silva, Giorgio Quadri, Francesco Tomassini, Cristina Rolfo, Etelberto Hernández Hernández, José Antonio Baz Alonso, Andrés Íñiguez Romo, Giulia Teresi, Giuseppe Andolina, Simone Calcagno, Gonzalo Navarrete, Fernando Rivero, Javier Cuesta, Daniella Benedetto, Fatih Arslan, Peter R Stella, Mª Isabel Barrionuevo Sánchez, Rafael Gómez Vicente, Patricia Clares Montón, Dámaris Carballeira, Geoffrey Yanes Bowden, Manuel Vargas Torres, Agustín Fernández Cisnal, Juan Pablo Canepa Leite, Giulietta Grigis, Claudio Moretti, Antonio Montefusco, Fabrizio D'Ascenzo, Piera Capasso, Marta Bande, Francesco Casilli, Ramez Morkous, Eric Yang, Harish Ramakrishna, Martin Poloczek, Roman Miklik, Ahmad Al Hallak, Bernardo Cortese, Pilar Jiménez Quevedo, Nieves Gonzalo, María Del Trigo, Alfonso de Hoyos Y Fernández de Córdova, Jose Alberto de Agustín, Armghan Munir, David Vivas, Iván J Núñez-Gil, Enrico Cerrato, Mario Bollati, Luis Nombela-Franco, Belén Terol, Emilio Alfonso-Rodríguez, Santiago J Camacho Freire, Pedro A Villablanca, Ignacio J Amat Santos, José M de la Torre Hernández, Isaac Pascual, Christoph Liebetrau, Benjamín Camacho, Marco Pavani, Juan Albistur, Roberto Adriano Latini, Ferdinando Varbella, Víctor Alfonso Jiménez-Díaz, Davide Piraino, Massimo Mancone, Fernando Alfonso, José Antonio Linares, Ramón Rodríguez-Olivares, Jesús M Jiménez Mazuecos, Jorge Palazuelos Molinero, Alejandro Sánchez-Grande Flecha, Joan Antoni Gomez-Hospital, Alfonso Ielasi, Íñigo Lozano, Pierluigi Omedè, Rodrigo Bagur, Fabrizio Ugo, Massimo Medda, Boshra F Louka, Petr Kala, Javier Escaned, Daniel Bautista, Gisela Feltes, Pablo Salinas, Mohamad Alkhouli, Carlos Macaya, Antonio Fernández-Ortiz, CAAR investigators, Piter Martínez Benítez, Antonio Gomez Menchero, Javier León Jimenez, José Francisco Díaz Fernandez, Mohammed Makkiya, Nurilign Bulcha, Sarabjeet Suri, Paol Rojas, Tamara Garcia Camarero, Pablo Avanzas, Cesar Morís, Christoph Berndt, Pedro Trujillo, Gustavo Vignolo, Rafael Mila, Dario Buccheri, Pedro Silva, Giorgio Quadri, Francesco Tomassini, Cristina Rolfo, Etelberto Hernández Hernández, José Antonio Baz Alonso, Andrés Íñiguez Romo, Giulia Teresi, Giuseppe Andolina, Simone Calcagno, Gonzalo Navarrete, Fernando Rivero, Javier Cuesta, Daniella Benedetto, Fatih Arslan, Peter R Stella, Mª Isabel Barrionuevo Sánchez, Rafael Gómez Vicente, Patricia Clares Montón, Dámaris Carballeira, Geoffrey Yanes Bowden, Manuel Vargas Torres, Agustín Fernández Cisnal, Juan Pablo Canepa Leite, Giulietta Grigis, Claudio Moretti, Antonio Montefusco, Fabrizio D'Ascenzo, Piera Capasso, Marta Bande, Francesco Casilli, Ramez Morkous, Eric Yang, Harish Ramakrishna, Martin Poloczek, Roman Miklik, Ahmad Al Hallak, Bernardo Cortese, Pilar Jiménez Quevedo, Nieves Gonzalo, María Del Trigo, Alfonso de Hoyos Y Fernández de Córdova, Jose Alberto de Agustín, Armghan Munir, David Vivas
Abstract
Background: Coronary Aneurysms are a focal dilatation of an artery segment >1.5-fold the normal size of adjacent segments. Although some series have suggested a prevalence of 0.3-12%, data are lacking. In addition, they are not mentioned in practice guidelines. Our aim was investigate its prevalence, management and long-term outcomes.
Methods and results: The coronary artery aneurysm registry (CAAR) involved 32 hospitals across 9 countries in America and Europe. We reviewed 436,467 consecutive angiograms performed over the period 2004-2016. Finally, 1565 patients were recruited. Aneurysm global prevalence was 0.35%. Most patients were male (78.5%) with a mean age of 65 years and frequent cardiovascular risk factors. The main indication for angiogram was an acute coronary syndrome, 966 cases. The number of aneurisms was ≤2 per patient in 95.8% of the cases, mostly saccular, most frequently found in the left anterior descending and with numbers proportional with coronary stenosis. Aortopathies were related with more aneurysms too. Most patients received any revascularization procedure (69%), commonly percutaneous (53%). After a median follow-up of 37.2 months, 485 suffered a combined event (MACE) and 240 died. Without major differences comparing CABG vs PCI, MACE and death were more frequent in patients who received bare metal stents.
Conclusions: Coronary artery aneurysms are not uncommon. Usually, they are associated with coronary stenosis and high cardiovascular risk. Antiplatelet therapy seems reasonable and a percutaneous approach is safe and effective.
Copyright © 2019 Elsevier B.V. All rights reserved.
Source: PubMed