Coronary ectasia in Jordanians: angiographic and clinical characteristics, 21 month prognosis, and a proposed new classification

ABSTRACT

to determine the frequency, underlying risk factors, treatment methods, complications, and prognosis of patients with pure coronary ectasia in the study group. we conducted a retrospective analysis of all coronary angiograms performed at the catheterization laboratory of Jordan University Hospital [JUH], a tertiary referral center, between the period of December 1997 and December 2000. A 21-month follow up was performed to look for primary and secondary endpoints. The primary endpoint was the major adverse cardiac event [MACE] a composite end point of unstable angina with ECG changes, myocardial infarction or cardiac death; secondary endpoints were recurrent chest pain, need for repeat cardiac catheterization, emergency room visits for chest pain, and hospital admission for chest pain. Data were collected from catheterization films, medical records, and a telephone questionnaire results four thousand and two hundred and five coronary angiograms were performed during the period of the study. One hundred angiograms [2.4%] showed coronary ectasia of both mixed and pure types. Sixty angiograms [1.4%] showed pure ectasia with no coronary obstructive lesions. The left anterior descending artery [LAD] was the most commonly affected vessel by ectasia [93%], followed by the right coronary artery [RCA] [64%] and the circumflex artery in 57% of the patients. The primary composite endpoint [MACE] was observed in 4 patients [6.8%] including one patient [1.7%] with none ST elevation MI [NSTEMI], one [1.7%] with ST elevation inferior wall MI, one [1.7%] with unstable angina with ECG changes, and one [1.7%] death due to pulmonary edema. The secondary endpoint of recurrent chest pain was reported by 50% of the patients at the time of follow up. Twenty seven percent presented to the emergency room during this period with chest pain, and 17% required admission to the hospital due to chest pain. Repeated cardiac catheterization was needed in 5% of patients. Therefore, over a period of 21 months, patients with ectasia were at a high risk for recurrent chest pain, but have a low risk of MI and a low mortality rate a discussion of treatment modalities and a proposed new classification for ectasia are provided. coronary ectasia remains a controversial disease in its definition, etiology, and management. A prospective randomized trial is needed to find the best therapeutic approach to its management