Background 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. Methods 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). Results 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). Conclusions Adult ICAE exhibits distinct clinical and angiographic features, consistent with a chronic ischemia–like phenotype and possible association with elevated MACE risk.
Weng et al. (Thu,) studied this question.