CLINICAL PRESENTATION, NATURAL HISTORY AND MANAGEMENT OF CORONARY ARTERY ECTASIA

1388 JACC March 21, 2017 Volume 69, Issue 11

Interventional Cardiology CLINICAL PRESENTATION, NATURAL HISTORY AND MANAGEMENT OF CORONARY ARTERY ECTASIA Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: Interventional Cardiology: PCI in Complex Patients Abstract Category: 19. Interventional Cardiology: Complex Patients/Comorbidities Presentation Number: 1287-192 Authors: Prasad C. Gunasekaran, Reza Masoomi, Dusan Stanojevic, Taylor Drees, John Fritzlen, Megan Haghnegahdar, Matthew McCullough, Ashwani Mehta, Matthew Earnest, Mark Wiley, Eric Hockstad, Peter Tadros, Kamal Gupta, University of Kansas, Kansas City, KS, USA Background: Clinical presentation, natural history of coronary artery ectasia (CAE) and prognostic implications of its anatomic classification of are not well known.

Methods: We retrospectively analyzed 376 consecutive cases of CAE and angiographically categorized them using the Markis classification (Type I: Diffuse ectasia of 2-3 vessels; type II: diffuse in 1 vessel; localized in another; type III: diffuse, 1 vessel; type IV: localized/segmental ectasia). High (Markis I/II) and low grade CAE (Markis III/IV) groups were compared for clinical characteristics and outcomes.

Results: The majority of patients were white (90%) with a mean age of 70±12 years. Table 1 describes baseline/outcomes data over a mean follow up of 6.4±3.6 years. At baseline, the high grade CAE group had a higher prevalence of < TIMI 3 (slow) flow but lower prevalence of angiographic occlusive CAD. They had a higher incidence of acute coronary syndromes (ACS) on follow up and were less likely to be on optimal medical therapy (OMT).

Conclusions: The current anatomic CAE classification has prognostic significance, with higher grade CAE patients having a higher incidence of ACS on follow up despite having less extensive baseline angiographic CAD. This group had a higher prevalence of < TIMI 3 flow at baseline that may have contributed to ACS on follow up. These patients were less likely to be on OMT compared to low grade CAE, likely due to lesser extent of CAD at baseline. High grade CAE are a high risk group that merits close follow up and management. Table 1. Comparison of Clinical Characteristics and Outcomes in Patients with Low and High Grade Coronary Artery Ectasias High Grade Low Grade High Grade Low Grade Baseline CAEMarkis I/ CAEMarkis III/ P value CAEMarkis I/ CAEMarkis III/ P value Characteristics II(n=200) IV(n=176) II(n=200) IV(n=176) Presentation on index cardiac catheterization Positive stress test

22%

15%

0.03

Unstable angina

23%

28%

<0.01

NSTEMI

16%

33%

<0.01

STEMI 5% 2% Others* 34% 22% Extent of underlying obstructive CAD (index angiogram) Non occlusive CAD 38% 15%

0.02

1-vessel CAD

<0.01

23%

29%

<0.01 0.02

Outcomes of CAE Patients (Follow Up 6.4±3.6 Years) Positive 12% 5% stress test Any form of 13% 7% ACS All-cause 30% 28% mortality

Medications following index angiogram: Aspirin 71% 92% Dual-antiplatelet 16% 22% therapy Statins 64% 86%

<0.01 0.01 0.9

0.01 0.04

Multi-vessel CAD 39% 56% <0.01 <0.01 Prevalence of slow flow ( 50% left main disease or ≥70% stenosis in any other artery); CAE: coronary artery ectasia; LVEF: left ventricular ejection fraction; NSTEMI: non-ST elevation myocardial infarction; STEMI: ST elevation myocardial infarction. p<0.05 indicates statistical significance; *Others: stable angina refractory to medical therapy, recurrent arrhythmias, workup of valvular heart disease or perioperative risk assessment.