Post-PCI outcomes in STEMI patients with coronary ectasia: meta-analysis

ABSTRACT

Background

Coronary ectasia (CE) is defined as dilation of the coronary artery, 1.5 times that of the surrounding vessel. Outcomes of percutaneous intervention (PCI) in patients with CE presenting as ST-elevated myocardial infarction (STEMI) remain a topic of debate.

Methods

Studies comparing outcomes of PCI in CE versus no-ectasia (NE) STEMI patients were identified. Baseline angiographic characteristics include thrombolysis in myocardial infarction (TIMI) 0–1 flow, right coronary artery (RCA) involvement, and primary outcomes including thrombus aspiration, no-reflow, mortality, and TIMI-3 post-PCI. Odds ratio (OR) and 95% confidence interval (CI) were calculated.

Results

Six studies (n = 5746, CE-340 and NE-5406) qualified for the analysis. RCA involvement was more common in CE than NE, OR-1.39 (95%CI1.06–1.82, p-0.02). Pre-procedure TIMI-0-1 was of comparable results between the groups (p-1.13). Higher thrombus aspiration for CE (OR 2.18, 95%CI1.44–3.32;p-<0.001). CE had higher incidence of no-reflow (OR 4.07, 95%CI2.42–6.84;p-<0.001). TIMI-3 flow post-PCI was achieved less commonly in the CE group (OR-0.64, 95%CI-0.48–0.86;p-<0.001). Mortality on follow-up was comparable (0.83, 95%CI0.39–1.78;p-0.63). Metaregression analysis did not show confounding effects from comorbidities.

Conclusion

Coronary ectasia patients with STEMI had higher rates of PCI failure and no-reflow than NE; however, mortality during follow-up was comparable.

KEYWORDS:

• Coronary ectasia
• coronary artery aneurysm
• stemi
• pci

Article highlights

1. The study is the first of its type to compare coronary ectasia with no-ectasia patients presenting with STEMI.

2. Our study reveals that RCA is the main culprit vessel in coronary ectasia.

3. Coronary ectasia is associated with higher rates of PCI failure with high rates of no-reflow and low post-PCI TIMI-3 flow rates.

4. Overall mortality results on follow-up are comparable between coronary ectasia and no-ectasia STEMI patients.

5. Our study reveals that CE has higher rates of thrombus aspiration on angiography, which reveals the high thrombus burden associated with coronary ectasia.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose 

Additional information

Funding

This paper was not funded.