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Coronary artery disease
Original research
Coronary artery aneurysms: outcomes following medical, percutaneous interventional and surgical management
  1. Shameer Khubber1,
  2. Rajdeep Chana1,
  3. Chandramohan Meenakshisundaram1,
  4. Kamal Dhaliwal1,
  5. Mohomed Gad1,
  6. Manpreet Kaur1,
  7. Kinjal Banerjee2,
  8. Beni Rai Verma1,
  9. Shashank Shekhar1,
  10. Muhummad Zia Khan3,
  11. Muhammad Shahzeb Khan4,
  12. Safi Khan5,
  13. Yasser Sammour1,
  14. Rayji Tsutsui1,
  15. Rishi Puri1,
  16. Ankur Kalra6,
  17. Faisal G Bakaeen1,
  18. Conrad Simpfendorfer1,
  19. Stephen Ellis1,
  20. Douglas Johnston1,
  21. Gosta Pettersson7 and
  22. Samir Kapadia1
  1. 1Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
  3. 3Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
  4. 4Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
  5. 5Department of Medicine, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
  6. 6Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
  7. 7Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Samir Kapadia; kapadis{at}ccf.org

Abstract

Background Coronary artery aneurysms (CAAs) are increasingly diagnosed on coronary angiography; however, controversies persist regarding their optimal management. In the present study, we analysed the long-term outcomes of patients with CAAs following three different management strategies.

Methods We performed a retrospective review of patient records with documented CAA diagnosis between 2000 and 2005. Patients were divided into three groups: medical management versus percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). We analysed the rate of major cardiovascular and cerebrovascular events (MACCEs) over a period of 10 years.

Results We identified 458 patients with CAAs (mean age 78±10.5 years, 74.5% men) who received medical therapy (N=230) or underwent PCI (N=52) or CABG (N=176). The incidence of CAAs was 0.7% of the total catheterisation reports. The left anterior descending was the most common coronary artery involved (38%). The median follow-up time was 62 months. The total number of MACCE during follow-up was 155 (33.8%); 91 (39.6%) in the medical management group vs 46 (26.1%) in the CABG group vs 18 (34.6%) in the PCI group (p=0.02). Kaplan-Meier survival analysis showed that CABG was associated with better MACCE-free survival (p log-rank=0.03) than medical management. These results were confirmed on univariate Cox regression, but not multivariate regression (OR 0.773 (0.526 to 1.136); p=0.19). Both Kaplan-Meier survival and regression analyses showed that dual antiplatelet therapy (DAPT) and anticoagulation were not associated with significant improvement in MACCE rates.

Conclusion Our analysis showed similar long-term MACCE risks in patients with CAA undergoing medical, percutaneous and surgical management. Further, DAPT and anticoagulation were not associated with significant benefits in terms of MACCE rates. These results should be interpreted with caution considering the small size and potential for selection bias and should be confirmed in large, randomised trials.

  • coronary artery disease
  • coronary aneurysm
  • coronary vessels
  • percutaneous coronary intervention
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2020-001440

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    Footnotes

    • Contributors Data collection, analysis and writing of the manuscript: SK, RC, CM and AK. Review of the angiogram images: RT. Editing and writing of the manuscript: RP, FGB, CS, SE, DJ, GP and SK. Statistical analysis: MZK, MSK and SK. Data collection: KD, MG, MK, KB, BRV, YS, JR and KA. SK is responsible for the overall content of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study protocol was approved by the institutional review board at the Cleveland Clinic.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. All patient data were de-identified.