TY - JOUR T1 - Coronary artery aneurysms: outcomes following medical, percutaneous interventional and surgical management JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2020-001440 VL - 8 IS - 1 SP - e001440 AU - Shameer Khubber AU - Rajdeep Chana AU - Chandramohan Meenakshisundaram AU - Kamal Dhaliwal AU - Mohomed Gad AU - Manpreet Kaur AU - Kinjal Banerjee AU - Beni Rai Verma AU - Shashank Shekhar AU - Muhummad Zia Khan AU - Muhammad Shahzeb Khan AU - Safi Khan AU - Yasser Sammour AU - Rayji Tsutsui AU - Rishi Puri AU - Ankur Kalra AU - Faisal G Bakaeen AU - Conrad Simpfendorfer AU - Stephen Ellis AU - Douglas Johnston AU - Gosta Pettersson AU - Samir Kapadia Y1 - 2021/02/01 UR - http://openheart.bmj.com/content/8/1/e001440.abstract N2 - 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. ER -