Key result
In patients with coronary artery ectasia and acute coronary syndrome, combining anticoagulant and antiplatelet therapy resulted in no recurrent myocardial infarctions (0/9) compared to a 46% recurrence rate with DAPT alone (6/13).
Why the study?
Coexistence of coronary artery ectasia and ACS is associated with poor outcomes, but evidence regarding the role of anticoagulant therapy and covered stents remains limited.
Does the addition of anticoagulant therapy or the use of covered stents reduce recurrent ischemic events in patients with coronary artery ectasia presenting with acute coronary syndrome?
Systematic Review (n=31)
Does the addition of anticoagulant therapy or the use of covered stents reduce recurrent ischemic events in patients with coronary artery ectasia presenting with acute coronary syndrome?
In patients with coronary artery ectasia presenting with ACS, adding an anticoagulant to antiplatelet therapy or using covered stents may reduce the risk of recurrent ischemic events.
Answers are grounded in this paper and cite their sources.
Role of anticoagulation in CAE-ACS remains uncertain from case reports; leaves open need for prospective trials.
Background: The coexistence of coronary artery ectasia (CAE) and acute coronary syndrome (ACS) is uncommon and associated with poor clinical outcomes. However, evidence regarding the role of anticoagulant therapy and covered stents in this context remains limited. Methods: To evaluate the potential impact of anticoagulant therapy in patients with CAE and ACS, we conducted a comprehensive systematic review of case reports and case series published up to August 2022. Results: Our findings suggest that anticoagulant therapy may be beneficial in preventing ACS in patients with CAE. The adjunctive use of single or dual antiplatelet therapy should be individualized based on bleeding risk. In addition, covered stents may represent a viable treatment option, particularly for short lesions. Conclusion: Patients with CAE often present with ACS and require tailored management strategies owing to altered vessel morphology and flow dynamics. Evidence from case series suggests that the combination of antiplatelet and anticoagulant therapy may reduce ischemic recurrence without a marked increase in bleeding events. Covered stents offer a viable intervention for short, isolated ecstatic segments.
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Chou et al. (2025) conducted a systematic review in Acute Coronary Syndrome with Coronary Artery Ectasia (n=31). Anticoagulant therapy combined with antiplatelet therapy vs. Dual antiplatelet therapy (DAPT) alone was evaluated on Recurrent acute coronary syndrome / myocardial infarction. In patients with coronary artery ectasia and acute coronary syndrome, combining anticoagulant and antiplatelet therapy resulted in no recurrent myocardial infarctions (0/9) compared to a 46% recurrence rate with DAPT alone (6/13).
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