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This study was supported by an unconditioned grant from Fundacion "Interhospitalaria para la" Investigacion Cardiovascular (FIC). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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Long-Term Prognosis of Coronary Aneurysms Insights of CAAR, an International Registry

Publicated to:JACC-Cardiovascular Interventions. 17 (22): 2681-2691 - 2024-11-25 17(22), DOI: 10.1016/j.jcin.2024.08.034

Authors: Sanchez-Sanchez, Ivan; Cerrato, Enrico; Bollati, Mario; Espejo-Paeres, Carolina; Nombela-Franco, Luis; Alfonso-Rodriguez, Emilio; Camacho-Freire, Santiago J; Villablanca, Pedro A; Amat-Santos, Ignacio J; Hernandez, Jose M De la Torre; Pascual, Isaac; Liebetrau, Christoph; Camacho, Benjamin; Pavani, Marco; Albistur, Juan; Latini, Roberto Adriano; Varbella, Ferdinando; Diaz, Victor Alfonso Jimenez; Piraino, Davide; Mancone, Massimo; Alfonso, Fernando; Linares, Jose Antonio; Rodriguez-Olivares, Ramon; Jimenez-Mazuecos, Jesus M; Molinero, Jorge Palazuelos; Flecha, Alejandro Sanchez-Grande; Gomez-Hospital, Joan Antoni; Ielasi, Alfonso; Lozano, Inigo; Omede, Pierluigi; Feltes, Gisela; Ugo, Fabrizio; Medda, Massimo; Ramakrishna, Harish; Kala, Petr; Bautista, Daniel; Alkhouli, Mohamad; Fernandez-Ortiz, Antonio; Nunez-Gil, Ivan J

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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. (JACC Cardiovasc Interv. 2024;17:2681-2691) (c) 2024 by the American College of Cardiology Foundation.

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