Underlying factors relating to acute myocardial infarction for coronary artery ectasia patients

Chronic exposure to high altitude and the presence of coronary ectasia in patients with ST elevation myocardial infarction

Objective

To evaluate the association between chronic exposure to high altitude and the presence of coronary ectasia (CE) in patients with ST-segment elevation myocardial infarction (STEMI) treated in a highly specialized cardiovascular reference hospital in Peru.

Materials and methods

Retrospective matched case-control study. The cases were patients with CE and controls without CE. The relationship between CE and chronic exposure to high altitude was evaluated considering intervening variables such as arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and hematocrit values. Patients with chronic inflammatory pathologies, chronic obstructive pulmonary disease, and previous revascularization were excluded. Multivariate logistic regression was applied to obtain the OR value and their respective confidence intervals.

Results

Eighteen cases and 18 controls were studied, most of them were men with an average age of 65 years. Thirty-six percent of the population came from high altitude; in this group 76.9% had coronary ectasia of the infarct-related artery. The mean hematocrit value was slightly higher in the high-altitude native (46 ± 7% versus 42 ± 5%, p=0.094). Multivariate conditional logistic regression did not find a significant relationship between exposure to high altitude and the risk of presenting CE (OR:6.03, IC95%: 0.30-118, p=0.236).

Conclusions

In patients with STEMI, we found no association between chronic exposure to high altitude and coronary ectasia.

Five-years' prognostic analysis for coronary artery ectasia patients with coronary atherosclerosis: A retrospective cohort study

Background

Most of coronary artery ectasia (CAE) patients have comorbid coronary atherosclerosis. It was lack of prognostic data for CAE patients with coronary heart disease (CHD) and for whom with acute myocardial infarction (AMI).

Objective

To determine the overall prognosis for CAE patients.

Materials and methods

This study was a retrospective cohort study. Fifty-one patients with CAE and comorbid AMI (CAE + AMI) and 108 patients with CAE and comorbid CHD (CAE + CHD) were enrolled and matched to non-CAE subjects at a ratio of 1:3 using a propensity score method, respectively. Controls for CAE + AMI group were 153 AMI patients, controls for CAE group were 324 CHD patients and 329 participants with relatively normal coronary arteries (CON). We followed them up to observe major cardiovascular events (MACE).

Results

The Kaplan-Meier curves showed that the prognosis in CAE + AMI group was worse than in AMI group (5-year non-MACE rate: 62.70% vs. 79.70%, P = 0.010), the prognosis in CAE group was worse than in CHD and CON groups (5-year non-MACE rate: 74.10% vs. 85.80% and 96.70%, respectively, P = 0.000). The main MACEs in CAE + AMI and CAE groups were AMI reoccurrence (19.61% vs. 4.57%, P = 0.002) and re-hospitalization due to repeated angina pectoris (14.81% vs. 8.33% and 2.74%, P = 0.000), respectively. Additionally, the COX regression analysis revealed that the protective factors for preventing MACE in CAE + AMI group included antiplatelet agents (hazard ratio = 0.234, P = 0.016) and angiotensin-converting enzyme inhibitor/angiotensin receptor inhibitor (ACEI/ARB, hazard ratio = 0.317, P = 0.037). Whereas the main factor promoting MACE in CAE group was the degree of coronary stenosis (Gensini score, hazard ratio = 1.011, P = 0.022).

Conclusion

The prognosis of patients with CAE + AMI was worse than that of those with AMI. The overall prognosis of patients with CAE was worse than that of those with CHD. CAE + AMI and CAE groups had different characteristics; the former was prone to AMI reoccurrence, and the latter was prone to repeated angina pectoris. To prevent MACE, medications, including antiplatelets and ACEI/ARBs, are indicated for patients with CAE + AMI, whereas prevention of the progression of atherosclerotic lesions is indicated for patients with CAE.

Coronary Artery Ectasia in the Pathophysiology of Myocardial Infarction With Nonobstructive Coronary Arteries

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.

Inflammatory Biomarkers in Coronary Artery Ectasia: A Systematic Review and Meta-Analysis

Isolated coronary artery ectasia (CAE) is a relatively rare clinical entity, the pathogenesis of which is poorly understood. More and more evidence is accumulating to suggest a critical inflammatory component. We aimed to elucidate any association between neutrophil to lymphocyte ratio and coronary artery ectasia. A systematic MEDLINE database, ClinicalTrials.gov, medRxiv, Scopus and Cochrane Library search was conducted: 50 studies were deemed relevant, reporting on difference in NLR levels between CAE patients and controls (primary endpoint) and/or on high-sensitive CRP, IL-6, TNF-a and RDW levels (secondary endpoint), and were included in our final analysis. (PROSPERO registration number: CRD42021224195). All inflammatory biomarkers under investigation were found higher in coronary artery ectasia patients as compared to healthy controls (NLR; SMD = 0.73; 95% CI: 0.27–1.20, hs-CRP; SMD = 0.96; 95% CI: 0.64–1.28, IL-6; SMD = 2.68; 95% CI: 0.95–4.41, TNF-a; SMD = 0.50; 95% CI: 0.24–0.75, RDW; SMD = 0.56; 95% CI: 0.26–0.87). The main limitations inherent in this analysis are small case-control studies of moderate quality and high statistical heterogeneity. Our findings underscore that inflammatory dysregulation is implicated in coronary artery ectasia and merits further investigation.

Distribution Characteristics of ST-Segment Elevation Myocardial Infarction and Non-ST-Segment Elevation Myocardial Infarction Culprit Lesion in Acute Myocardial Infarction Patients Based on Coronary Angiography Diagnosis

This research was aimed at exploring the application value of coronary angiography (CAG) based on a convolutional neural network algorithm in analyzing the distribution characteristics of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) culprit lesions in acute myocardial infarction (AMI) patients. Methods. Patients with AMI treated in hospital from June 2019 to December 2020 were selected as subjects. According to the results of an echocardiogram, the patients were divided into the STEMI group (44 cases) and the NSTEMI group (36 cases). All patients received CAG. All images were denoised and edge detected by a convolutional neural network algorithm. Then, the number of diseased vessels, the location of diseased vessels, and the degree of stenosis of diseased vessels in the two groups were compared and analyzed. Results. The number of patients with complete occlusion (3 cases vs. 12 cases) and collateral circulation (5 cases vs. 20 cases) in the NSTEMI group was significantly higher than that in the STEMI group, and the difference was statistically significant, P < 0.05. There was a statistically significant difference in the number of lesions between the distal LAD (1 case vs. 10 cases) and the distal LCX (4 cases vs. 11 cases), P < 0.05. There was a statistically significant difference in the number of patients with one lesion branch (1 vs. 18) and three lesion branches (25 vs. 12) between the two groups, P < 0.05. The image quality after the convolution neural network algorithm is significantly improved, and the lesion is more prominent. Conclusion. The convolutional neural network algorithm has good performance in DSA image processing of AMI patients. STEMI and NSTEMI as the starting point of AMI disease analysis to determine the treatment plan have high clinical application value. This work provided reference and basis for the application of the convolutional neural network algorithm and CAG in the analysis of the distribution characteristics of STEMI and NSTEMI culprit lesions in AMI patients.