1
|
Eyuboglu M, Eyuboglu C. Coronary Artery Ectasia in the Pathophysiology of Myocardial Infarction With Nonobstructive Coronary Arteries. Am J Cardiol 2022; 171:28-31. [PMID: 35287947 DOI: 10.1016/j.amjcard.2022.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/01/2022] [Accepted: 01/17/2022] [Indexed: 11/16/2022]
Abstract
Coronary artery ectasia (CAE) is associated with an increased risk for acute myocardial infarction (AMI). A significant proportion of patients with AMI have no obstructive coronary artery disease (CAD), however, the underlying mechanism of myocardial infarction with nonobstructive coronary arteries (MINOCA) is poorly understood. Therefore, the present study aimed to investigate whether CAE has a role in the pathogenesis of MINOCA. A total of 1,284 patients who were admitted with a diagnosis of non-ST-segment elevation myocardial infarction were included in the study. Patients were divided into 2 groups according to the presence or absence of obstructive CAD (≥50% stenosis). Patients without obstructive CAD (MINOCA group) and patients with obstructive CAD (no-MINOCA group) were compared regarding the frequency of CAE. Additionally, the association between CAE and MINOCA was investigated. In the study participants, 101 patients (7.9%) were diagnosed with MINOCA, whereas 1,183 (92.1%) had AMI with obstructive CAD. Importantly, the frequency of patients with CAE was significantly higher in patients with MINOCA compared with those with obstructive CAD (22.8% vs 3.5%, p <0.001). Moreover, CAE was observed in 64 patients (4.9%). The frequency of MINOCA was found to be significantly higher in patients with CAE compared with patients without CAE (35.9% vs 6.4%, p <0.001). Furthermore, multivariate analysis demonstrated that the presence of CAE was an independent predictor of MINOCA in patients presented with a diagnosis of non-ST-segment elevation myocardial infarction (odds ratio 1.812, 95% confidence interval 1.376 to 2.581, p <0.001). In conclusion, CAE may be considered as a risk factor for MINOCA and may have a role in the pathophysiology of MINOCA.
Collapse
Affiliation(s)
| | - Canan Eyuboglu
- Department of Anatomy, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| |
Collapse
|
2
|
Esenboğa K, Şahin E, Özyüncü N, Tan TS, Atmaca Y. Apixaban for massive intracoronary thrombosis: A case series. Anatol J Cardiol 2021; 25:661-664. [PMID: 34498598 DOI: 10.5152/anatoljcardiol.2021.32746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Kerim Esenboğa
- Department of Cardiology, Faculty of Medicine, Ankara University; Ankara-Turkey
| | - Ebru Şahin
- Department of Cardiology, Bilecik Training and Research Hospital; Bilecik-Turkey
| | - Nil Özyüncü
- Department of Cardiology, Faculty of Medicine, Ankara University; Ankara-Turkey
| | - Türkan Seda Tan
- Department of Cardiology, Faculty of Medicine, Ankara University; Ankara-Turkey
| | - Yusuf Atmaca
- Department of Cardiology, Faculty of Medicine, Ankara University; Ankara-Turkey
| |
Collapse
|
3
|
Jaglan A, Ajam T, Port SC, Bajwa T, Tajik AJ. A pebble clogging a river: a case report of thrombosed coronary aneurysmal ectasia. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33628993 PMCID: PMC7891237 DOI: 10.1093/ehjcr/ytaa274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/24/2020] [Accepted: 07/22/2020] [Indexed: 11/24/2022]
Abstract
Background Coronary artery ectasia (CAE) is a rare anomaly that can present at any age. Predisposing risk factors include Kawasaki disease in a younger population and atherosclerosis in the older generation. We present a unique case of the management of a young woman diagnosed with multivessel CAE with aneurysmal changes in the setting of acute coronary syndrome and subsequently during pregnancy. Case summary A 23-year-old woman presented with acute onset chest pain. Electrocardiogram revealed no ischaemic changes; however, troponin I peaked at 16 ng/mL (reference range 0–0.04 ng/mL). Echocardiogram showed apical dyskinesis with preserved left ventricular ejection fraction. Coronary angiography showed multivessel CAE along with significant thrombus burden in an ectatic lesion of the left anterior descending artery. Since the patient was haemodynamically stable, conservative management with dual antiplatelet therapy and anticoagulation was started. On follow-up, coronary computed tomographic angiogram illustrated resolution of the coronary thrombi and echocardiogram showed improvement to the apical dyskinesis. It was presumed that Kawasaki disease was the most likely aetiology of her disease. Subsequently the patient reported that, contrary to medical advice, she was pregnant, adding another layer of complexity to her case. Discussion Coronary artery ectasia can be discovered as an incidental finding or can present with an acute coronary syndrome. Management is challenging in the absence of randomized trials and large-scale data. Treatment options include medications, percutaneous intervention, and surgical revascularization. Close surveillance is required in these patients to assess progression of disease. Here we discuss treatment options during acute coronary syndrome and pregnancy.
Collapse
Affiliation(s)
- Akshar Jaglan
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Tarek Ajam
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Steven C Port
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Tanvir Bajwa
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - A Jamil Tajik
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| |
Collapse
|
4
|
Chen T, Li J, Xu Q, Li X, Lv Q, Wu H. Antithrombotic Therapy of a Young Adult with Giant Left Main Coronary Artery Aneurysm. Int Heart J 2020; 61:601-605. [PMID: 32350203 DOI: 10.1536/ihj.19-451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Giant coronary artery aneurysm (CAA) is a rare disorder, defined as coronary artery dilatation, in which the diameter of the coronary artery exceeds more than 1.5 times of its normal size. The most common cause of CAA is coronary atherosclerosis for adults and Kawasaki disease (KD) for children and adolescents (especially for the giant CAA that occurred in adolescence). CAA complications include thrombus, acute myocardial infarction (AMI), vasospasm, rupture, ischemia, heart failure, and arrhythmia. So, antithrombotic therapy is crucial for patients with giant CAA.Although giant CAA has been reported in some cases before, few of these cases described antithrombotic therapy particularly, let alone informed direct oral anticoagulant (DOAC) use in these patients. Here, we report a case of a young patient with acute coronary artery disease caused by huge CAA. Rivaroxaban combined with clopidogrel was used for his antithrombotic therapy. Moreover, we reviewed the existing reports to provide an overview of antithrombotic treatment in patients with giant CAA.
Collapse
Affiliation(s)
- Tingting Chen
- Department of Pharmacy, ZhongShan Hospital, FuDan University
| | - Jing Li
- Department of Pharmacy, ZhongShan Hospital, FuDan University
| | - Qing Xu
- Department of Pharmacy, ZhongShan Hospital, FuDan University
| | - Xiaoyu Li
- Department of Pharmacy, ZhongShan Hospital, FuDan University
| | - Qianzhou Lv
- Department of Pharmacy, ZhongShan Hospital, FuDan University
| | - Hongyi Wu
- Department of Cardiology, ZhongShan Hospital, FuDan University
| |
Collapse
|
5
|
Jafari J, Daum A, Hamed JA, Osherov A, Orlov Y, Yosefy C, Gallego-Colon E. Low High-Density Lipoprotein Cholesterol Predisposes to Coronary Artery Ectasia. Biomedicines 2019; 7:biomedicines7040079. [PMID: 31591337 PMCID: PMC6966440 DOI: 10.3390/biomedicines7040079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/02/2019] [Accepted: 10/05/2019] [Indexed: 01/10/2023] Open
Abstract
Coronary Artery Ectasia (CAE) is a phenomenon characterized by locally or diffuse coronary artery dilation of one or more coronary arteries. In the present study, the prevalence of acquired coronary ectasia and coronary risk factors for CAE was analyzed in patients undergoing cardiac catheterization for suspected ischemic heart disease. We retrospectively analyzed 4000 patients undergoing coronary angiography for suspected coronary artery disease at our cardiac catheterization unit, and a total of 171 patients were selected. The study group was divided into three groups, 65 patients with CAE, 62 patients with significant obstructive coronary artery disease, and 44 patients with normal coronary angiograms as a control group. A negative correlation was observed between high-density lipoprotein cholesterol (HDL-C) and the presence of CAE (r = −0.274, p < 0.001). In addition, HDL-C (OR, 0.858; CI, 0.749–0.984; p = 0.029), low-density lipoprotein cholesterol (LDL-C)/HDL-C ratio (OR, 1.987; CI, 1.542–2.882; p = 0.034), and hemoglobin (OR, 2.060; CI, 1.114–3.809; p = 0.021) were identified as independent risk factors for the development of CAE. In fact, we observed that a one-unit increase in HDL-C corresponded to a 15% risk reduction in CAE development and that each unit increase in hemoglobin could potentially increase the CAE risk by 2-fold. Low HDL-C could significantly increase the risk of developing CAE in healthy individuals. Elevated hemoglobin could predispose to subsequent dilation and aneurysm of the coronary artery. This work suggests that disordered lipoprotein metabolism or altered hemoglobin values can predispose patients to aneurysmal coronary artery disease.
Collapse
Affiliation(s)
- Jamal Jafari
- Cardiology Department, Barzilai University Medical Center, Hahistadrout St 2, 30604 Ashkelon, Israel
| | - Aner Daum
- Cardiology Department, Barzilai University Medical Center, Hahistadrout St 2, 30604 Ashkelon, Israel
| | - Jihad Abu Hamed
- Cardiology Department, Barzilai University Medical Center, Hahistadrout St 2, 30604 Ashkelon, Israel
| | - Azriel Osherov
- Cardiology Department, Barzilai University Medical Center, Hahistadrout St 2, 30604 Ashkelon, Israel
| | - Yan Orlov
- Cardiology Department, Barzilai University Medical Center, Hahistadrout St 2, 30604 Ashkelon, Israel
| | - Chaim Yosefy
- Cardiology Department, Barzilai University Medical Center, Hahistadrout St 2, 30604 Ashkelon, Israel
| | - Enrique Gallego-Colon
- Cardiology Department, Barzilai University Medical Center, Hahistadrout St 2, 30604 Ashkelon, Israel.
| |
Collapse
|
6
|
Waqas M, Bizzocchi LL, Menegus MA, Faillace RT. Coronary Artery Ectasia: An Insight into Intraprocedural and Postprocedural Management Strategies. Cureus 2019; 11:e3928. [PMID: 30931196 PMCID: PMC6430305 DOI: 10.7759/cureus.3928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Coronary artery ectasia (CAE) can present as an acute coronary syndrome (ACS) with a high clot burden in ectatic coronary arteries. Thrombectomy with intracoronary thrombolysis often does not ensure immediate blood flow. Also, there have not been clear guidelines regarding long-term management in such cases. A 40-year-old male presented with anginal chest discomfort and a working diagnosis of non-ST elevation myocardial infarction (NSTEMI) was made. The initial angiography showed thrombotic occlusion of several large and ectatic coronary arteries with visibly swirling blood flow. The culprit lesions were treated with balloon angioplasty and multiple rounds of thrombectomy yielding red thrombi. Interestingly, the post-intervention antegrade flow decreased in both vessels (Thrombolysis in Myocardial Infarction (TIMI) score: 0), possibly because of the distal migration of the clots. Peri-procedure, the patient received two boluses of eptifibatide, 180 mcg/kg each, followed by a continuous infusion of 2 mcg/kg/minute for 18 hours. Afterward, the patient was started on ticagrelor and continued on daily aspirin, high-intensity statin, beta blocker, and Coumadin® with heparin bridge. During the one year follow-up period, the Coumadin was switched to rivaroxaban, ticagrelor was stopped after six months, and the patient was continued on guideline-directed medical therapy (GDMT) for coronary artery disease (CAD) with favorable outcomes. The presented case gives us an insight into not only the intra-procedural but also the post-procedural management of ACS in the setting of CAE, and that is thrombectomy alone followed by longer duration oral anticoagulation in addition to GDMT for CAD. However, it will be interesting to see future studies aimed toward defining the duration as well as the choice of anticoagulation, i.e., dual antiplatelet therapy (DAPT) alone or in combination with warfarin/novel oral anticoagulants (NOACs).
Collapse
Affiliation(s)
- Muhammad Waqas
- Internal Medicine, Albert Einstein College of Medicine / Jacobi Medical Center, Bronx, USA
| | - Lilian L Bizzocchi
- Internal Medicine, Albert Einstein College of Medicine / Jacobi Medical Center, Bronx, USA
| | - Mark A Menegus
- Cardiology, Albert Einstein College of Medicine / Jacobi Medical Center, Bronx, USA
| | - Robert T Faillace
- Cardiology, Albert Einstein College of Medicine / Jacobi Medical Center, Bronx, USA
| |
Collapse
|
7
|
Tahir H, Kennedy T, Awan MU, Omar B, Malozzi C, Awan GM. Left Main Coronary Artery Diverticulum: Case Report and Review of the Literature. Cardiol Res 2018; 9:186-190. [PMID: 29904458 PMCID: PMC5997441 DOI: 10.14740/cr714w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/29/2018] [Indexed: 12/28/2022] Open
Abstract
Coronary artery disease is a major cause of morbidity and mortality, and while most commonly is atherosclerotic, it can present with variable manifestations, both congenital and acquired. One such manifestation is coronary aneurysm, which is a localized dilatation of a coronary artery wall segment to greater than 1.5 times the adjacent normal segments. While a dilated outpouching of a coronary artery has been commonly classified as a coronary aneurysm, a non-dilated outpouching is rare and is referred to as a diverticulum, with only one previous case report in the literature. It is conceivable that other cases of coronary artery diverticulum may have been previously reported as an aneurysm, given the overlapping angiographic appearance. We present a case of a 72-year-old female patient with an incidental finding of left main coronary artery diverticulum on diagnostic coronary angiogram done for preoperative liver transplantation evaluation.
Collapse
Affiliation(s)
- Hassan Tahir
- Division of Cardiology, University of South Alabama, Mobile, AL, USA
| | - Timothy Kennedy
- Division of Cardiology, University of South Alabama, Mobile, AL, USA
| | - M Umer Awan
- Division of Cardiology, University of South Alabama, Mobile, AL, USA
| | - Bassam Omar
- Division of Cardiology, University of South Alabama, Mobile, AL, USA
| | | | - G Mustafa Awan
- Division of Cardiology, University of South Alabama, Mobile, AL, USA
| |
Collapse
|
8
|
Chongprasertpon N, Coughlan JJ, Ibrahim M, Kiernan T. Spontaneous thrombosis in an ectatic right coronary artery. BMJ Case Rep 2018. [PMID: 29535100 DOI: 10.1136/bcr-2018-224428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | - Munir Ibrahim
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Thomas Kiernan
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| |
Collapse
|