Coronary Ectasia and ST Elevation Myocardial Infarction Patients: Does Atherosclerosis Influence Periprocedural Management and Long‐Term Prognosis?

Background Coronary artery ectasia (CAE) influences procedural outcomes in the context of ST‐elevation myocardial infarction (STEMI); however, its relationship with atherosclerotic coronary artery disease (ACAD) remains unclear. Aims This study aimed to compare clinical and procedural characteristics, as well as outcomes, in patients with STEMI and CAE, with or without coexisting ACAD. Methods Overall, 148 patients with STEMI and ectatic infarct‐related artery who underwent primary percutaneous intervention were included from 2003 to 2021. These patients were stratified based on the presence of atherosclerotic disease into two groups: patients with STEMI and isolated CAE ( n = 74) and those with CAE and coexisting ACAD ( n = 74). Results Compared with patients in the isolated CAE group, those in the CAE and coexisting ACAD groups were older (65 vs. 58.4 year, p = 0.002), with no significant differences in cardiovascular risk factors or initial clinical presentation. Coronary angioplasty was performed more frequently in the CAE with coexisting ACAD group (90.5% vs. 63.7%, p < 0.001), with a higher stenting rate (73.0% vs. 48.6%, p = 0.004) and a trend toward less frequent distal embolization (35.3% vs. 52.9%, p = 0.057). No significant differences were observed between the two groups in troponin or CPK levels, nor in left ventricular ejection fraction at hospital discharge (48 ± 10% vs. 49 ± 10%, p = 0.569). At the 3‐year follow‐up, the overall MACE‐free rate was 85.1%, with no significant difference between the groups (83.8% vs. 78.4%, p = 0.487). Conclusion Patients with STEMI and ectatic related infarct‐related artery who underwent primary PCI demonstrated distinct periprocedural characteristics depending on the presence or absence of coronary atherosclerosis. Further research is needed to determine optimal therapeutic management at discharge.