Takahito Doi1, Yu Kataoka2, Teruo Noguchi1, Tatsuhiro Shibata1, Takahiro Nakashima1, Shoji Kawakami1, Kazuhiro Nakao1, Masashi Fujino1, Toshiyuki Nagai1, Tomoaki Kanaya1, Yoshio Tahara1, Yasuhide Asaumi1, Etsuko Tsuda1, Michikazu Nakai1, Kunihiro Nishimura1, Toshihisa Anzai1, Kengo Kusano1, Hiroaki Shimokawa1, Yoichi Goto1, Satoshi Yasuda1. 1. From the Department of Cardiovascular Medicine (T.D., Y.K., T. Noguchi, T. Nakashima, S.K., K. Nakao, M.F., T. Nagai, T.K., Y.T., Y.A., T.A., K.K., Y.G., S.Y.), Department of Pediatric Cardiology (E.T.), and Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (M.N., K.N.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine (T.D., S.Y.) and Department of Cardiovascular Medicine (H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan; and Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan (T.S.). 2. From the Department of Cardiovascular Medicine (T.D., Y.K., T. Noguchi, T. Nakashima, S.K., K. Nakao, M.F., T. Nagai, T.K., Y.T., Y.A., T.A., K.K., Y.G., S.Y.), Department of Pediatric Cardiology (E.T.), and Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information (M.N., K.N.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine (T.D., S.Y.) and Department of Cardiovascular Medicine (H.S.), Tohoku University Graduate School of Medicine, Sendai, Japan; and Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan (T.S.). yu.kataoka@ncvc.go.jp.
Abstract
OBJECTIVE: Coronary artery ectasia (CAE) is an infrequently observed vascular phenotype characterized by abnormal vessel dilatation and disturbed coronary flow, which potentially promote thrombogenicity and inflammatory reactions. However, whether or not CAE influences cardiovascular outcomes remains unknown. APPROACH AND RESULTS: We investigated major adverse cardiac events (MACE; defined as cardiac death and nonfatal myocardial infarction [MI]) in 1698 patients with acute MI. The occurrence of MACE was compared in patients with and without CAE. CAE was identified in 3.0% of study subjects. During the 49-month observation period, CAE was associated with 3.25-, 2.71-, and 4.92-fold greater likelihoods of experiencing MACE (95% confidence interval [CI], 1.88-5.66; P<0.001), cardiac death (95% CI, 1.37-5.37; P=0.004), and nonfatal MI (95% CI, 2.20-11.0; P<0.001), respectively. These cardiac risks of CAE were consistently observed in a multivariate Cox proportional hazards model (MACE: hazard ratio, 4.94; 95% CI, 2.36-10.4; P<0.001) and in a propensity score-matched cohort (MACE: hazard ratio, 8.98; 95% CI, 1.14-71.0; P=0.03). Despite having a higher risk of CAE-related cardiac events, patients with CAE receiving anticoagulation therapy who achieved an optimal percent time in target therapeutic range, defined as ≥60%, did not experience the occurrence of MACE (P=0.03 versus patients with percent time in target therapeutic range <60% or without anticoagulation therapy). CONCLUSIONS: The presence of CAE predicted future cardiac events in patients with acute MI. Our findings suggest that acute MI patients with CAE are a high-risk subset who might benefit from a pharmacological approach to controlling the coagulation cascade.
OBJECTIVE:Coronary artery ectasia (CAE) is an infrequently observed vascular phenotype characterized by abnormal vessel dilatation and disturbed coronary flow, which potentially promote thrombogenicity and inflammatory reactions. However, whether or not CAE influences cardiovascular outcomes remains unknown. APPROACH AND RESULTS: We investigated major adverse cardiac events (MACE; defined as cardiac death and nonfatal myocardial infarction [MI]) in 1698 patients with acute MI. The occurrence of MACE was compared in patients with and without CAE. CAE was identified in 3.0% of study subjects. During the 49-month observation period, CAE was associated with 3.25-, 2.71-, and 4.92-fold greater likelihoods of experiencing MACE (95% confidence interval [CI], 1.88-5.66; P<0.001), cardiac death (95% CI, 1.37-5.37; P=0.004), and nonfatal MI (95% CI, 2.20-11.0; P<0.001), respectively. These cardiac risks of CAE were consistently observed in a multivariate Cox proportional hazards model (MACE: hazard ratio, 4.94; 95% CI, 2.36-10.4; P<0.001) and in a propensity score-matched cohort (MACE: hazard ratio, 8.98; 95% CI, 1.14-71.0; P=0.03). Despite having a higher risk of CAE-related cardiac events, patients with CAE receiving anticoagulation therapy who achieved an optimal percent time in target therapeutic range, defined as ≥60%, did not experience the occurrence of MACE (P=0.03 versus patients with percent time in target therapeutic range <60% or without anticoagulation therapy). CONCLUSIONS: The presence of CAE predicted future cardiac events in patients with acute MI. Our findings suggest that acute MI patients with CAE are a high-risk subset who might benefit from a pharmacological approach to controlling the coagulation cascade.
Authors: Juan Hernando Del Portillo; Boris Miguel Hernandez; María Angélica Bazurto; Dario Echeverri; Jaime Cabrales Journal: J Clin Sleep Med Date: 2022-02-01 Impact factor: 4.062
Authors: Diego Araiza-Garaygordobil; Rodrigo Gopar-Nieto; Daniel Sierra-Lara Martínez; Nallely Belderrain-Morales; Vianney Sarabia-Chao; Diana Laura Alfaro-Ponce; Heriberto Ontiveros-Mercado; Salvador Mendoza-García; Alfredo Altamirano-Castillo; Pablo Martinez-Amezcua; Alejandro Cabello-López; Jose Luis Briseño-De la Cruz; Maximiliano Ruiz-Beltrán; Marco Antonio Martínez-Ríos; Yigal Piña-Reyna; Hector Gonzalez-Pacheco; Alexandra Arias-Mendoza Journal: High Blood Press Cardiovasc Prev Date: 2022-07-29