Long-Term Prognosis of Coronary Aneurysms: Insights of CAAR, an International Registry
Recommended Citation
Sánchez-Sánchez I, Cerrato E, Bollati M, Espejo-Paeres C, Nombela-Franco L, Alfonso-Rodríguez E, Camacho-Freire SJ, Villablanca PA, Amat-Santos IJ, De la Torre Hernández JM, Pascual I, Liebetrau C, Camacho B, Pavani M, Albistur J, Latini RA, Varbella F, Jiménez Díaz VA, Piraino D, Mancone M, Alfonso F, Linares JA, Rodríguez-Olivares R, Jiménez-Mazuecos JM, Palazuelos Molinero J, Sánchez-Grande Flecha A, Gomez-Hospital JA, Ielasi A, Lozano Í, Omedè P, Feltes G, Ugo F, Medda M, Ramakrishna H, Kala P, Bautista D, Alkhouli M, Fernández-Ortiz A, and Núñez-Gil IJ. Long-Term Prognosis of Coronary Aneurysms: Insights of CAAR, an International Registry. JACC Cardiovasc Interv 2024; 17(22):2681-2691.
Document Type
Article
Publication Date
11-25-2024
Publication Title
JACC Cardiovasc Interv
Keywords
Aged, Female, Humans, Male, Middle Aged, Coronary Aneurysm, Europe, North America, Registries, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Cohort Studies
Abstract
BACKGROUND: Limited data are available to guide the management of coronary artery aneurysms (CAAs).
OBJECTIVES: The authors sought to define the clinical characteristics, identify variables that predict outcomes, and provide long-term data on CAAs.
METHODS: We describe outcomes from 1,729 consecutive patients with CAAs included in an ambispective international registry (CAAR [Coronary Artery Aneurysm Registry]; NCT02563626) involving 33 hospitals across 9 countries in America and Europe.
RESULTS: Patients were predominantly male (78.6%; 1,359/1,729) with a mean age of 66 years. Classic cardiovascular risk factors were common, as well as coronary artery disease (85.8%; 1,484/1,729), peripheral vascular disease (10.9%; 188/1,729), and chronic kidney disease (8.0%; 138/1,729). The median number of aneurysms per patient was 1.0 (Q1-Q3: 1.0-1.0), with the most affected territory being the left anterior descending artery (49.6%; 857/1,729). The majority underwent any revascularization procedure (68.5%; 1,184/1,729), mainly percutaneous coronary intervention (50.7%; 877/1,729), and were discharged on dual antiplatelet therapy (65.6%; 1,134/1,729). After a median follow-up of 44.8 months (Q1-Q3: 14.9-88.1), 379 died (21.9%), and 641 (37.1%) developed a major adverse cardiovascular event (MACE) (all-cause death, heart failure, unstable angina, and reinfarction). In a multivariable analysis, age (HR: 1.03; 95% CI: 1.02-1.04; P < 0.001), diabetes mellitus (HR: 1.47; 95% CI: 1.23-1.75; P < 0.001), renal insufficiency (HR: 1.53; 95% CI: 1.19-1.96; P = 0.010), peripheral vessel disease (HR: 1.43; 95% CI: 1.13-1.82; P = 0.003), reduced left ventricular ejection fraction (HR: 0.98; 95% CI: 0.98-0.99; P < 0.001), acute indication for the index coronary angiography (HR: 1.30; 95% CI: 1.08-1.55; P = 0.005), and the number of coronary vessels presenting severe stenosis (HR: 1.11; 95% CI: 1.02-1.20; P = 0.015) were independent predictors of MACEs. Remarkably, only 37 patients presented with local aneurysm complications during follow-up.
CONCLUSIONS: The long-term prognosis of CAAs is not favorable, with MACEs associated with the underlying risk factor profile for atherosclerotic heart disease.
Medical Subject Headings
Aged; Female; Humans; Male; Middle Aged; Coronary Aneurysm; Europe; North America; Registries; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Cohort Studies
PubMed ID
39603781
Volume
17
Issue
22
First Page
2681
Last Page
2691
