Impact of coronary artery ectasia on revascularization strategies and echocardiographic characteristics in patients presenting with ST-segment elevation myocardial infarction

Background Coronary artery ectasia (CAE) is a relatively rare phenomenon, characterized by a pathological, local or diffuse dilation more than 1.5 times the adjacent normal coronary artery segment. Echocardiographic assessment data in this patient population are conflicting, and risk factors associated with worse left ventricular ejection fraction (LVEF) in patients with CAE have not been studied. Purpose We explored treatment strategies, echocardiographic characteristics and their association in patients with CAE presenting with an ST-segment elevation myocardial infarction (STEMI). Methods Data were analysed retrospectively from CAE and STEMI registries. Revascularization strategies and factors associated with LVEF in CAE patients are reported. Results 1926 patients were included; 158 (8.2%) had CAE. Significant differences in the types of revascularization were observed: while stenting was the final revascularization strategy in 1755 (99.3%) controls, in CAE patients a more varied approach was implemented: 129 (81.6%) received stents, 10 (6.3%) were treated by balloon angioplasty, 3 (1.9%) received no revascularization and 16 (10.1%) patients required urgent or emergency coronary artery bypass grafting (CABG) (p <0.001 for difference between the groups). No association between Markis class and revascularization strategy was observed (p=0.29; Figure 1). Suboptimal final Thrombolysis in Myocardial Infarction (TIMI) flow was more common in the CAE group, compared to controls (29 (18.4%) versus 106 (6.0%); p<0.001). CAE patients had larger left atrial volume indices (30±9 ml/m2 versus 27±9 ml/m2; p=0.005), lower left ventricular (LV) filling pressures (9.6 (7.9; 11.8) versus 10.6 (8.5; 13.2); p=0.001) and worse LVEF (48±9% versus 50±8%; p<0.001). In the CAE patient group on multivariate linear regression analysis only peak troponin levels and CABG were associated with worse LVEF (Figure 2). Conclusions Patients with CAE presenting with STEMI were treated with more varied revascularization strategies and had higher rates of suboptimal final TIMI flow. These patients also had worse LVEF and larger left atrial volume indices compared to controls, despite lower LV filling pressures. In patients with CAE, only peak troponin levels and CABG were associated with worse LVEF.