Fluoroquinolone Exposure and Coronary Artery Ectasia: A Retrospective Angiography-Based Case-Control Study

Objective: Fluoroquinolones have been linked to collagen-related adverse events and aortic aneurysm or dissection, but their relationship with coronary artery ectasia (CAE) is unknown. We evaluated whether documented systemic fluoroquinolone exposure was associated with angiographically defined CAE and with CAE anatomic phenotype.Material and Methods: In this retrospective case-control study, 530 adults undergoing coronary angiography between January 2023 and May 2024 were included: 267 with CAE and 263 angiographic controls. The exposure was documented systemic fluoroquinolone use before angiography, ascertained from institutional prescribing and medication records. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) with sequential adjustment for demographics, cardiovascular risk factors, angiographic indication, and other antibiotic and non-steroidal anti-inflammatory drug exposure. Cumulative dose, active-comparator, overlap-weighted, and case-only analyses were supportive.Results: Fluoroquinolone exposure was present in 152 of 267 cases (56.9%) and 71 of 263 controls (27.0%). The unadjusted OR was 3.57, 95% CI [2.48, 5.15]; the association persisted after adjustment for measured clinical and medication covariates, OR = 3.83, 95% CI [2.61, 5.62], p < .001. Among 223 exposed participants, an exploratory dose trend was detected (adjusted OR per category = 2.55, 95% CI [1.66, 3.91], p < .001). Findings were consistent in active-comparator and overlap-weighted analyses. Among cases, no statistically significant association with multivessel or diffuse Markis type I/II CAE was detected.Conclusion: Documented fluoroquinolone exposure was associated with CAE after adjustment for measured covariates; no statistically significant association with angiographic extent was detected among CAE cases. These findings are hypothesis-generating and require confirmation in multicenter, pharmacy-linked studies.