Cardiovascular revascularization medicine : including molecular interventions · 2026
Prognostic impact of coronary artery ectasia after acute coronary syndrome: A systematic review and meta-analysis.
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Mohamed Ahmed Elmorsy, Abomohsen Mustafa, Gadelmawla Ahmed Farid, Sayed Rana S, Cogar Bryan, Sparling Jeffrey, Chrysant George, Gunsburg Moshe, Alaswad Khaldoon, Brilakis Emmanouil S, Megaly Michael
Аннотация
BACKGROUND: Coronary artery ectasia (CAE) is associated with abnormal coronary flow, thrombus formation, and impaired reperfusion, but its prognostic significance after acute coronary syndrome (ACS) remains uncertain.
OBJECTIVES: To evaluate clinical outcomes among patients with versus without CAE presenting with ACS.
METHODS: PubMed/MEDLINE and Scopus were searched from inception to April 2026 for studies comparing ACS patients with versus without CAE. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models with restricted maximum likelihood estimation and Hartung-Knapp adjustment. Subgroup, leave-one-out, and Bayesian random-effects analyses were performed to assess robustness.
RESULTS: Twelve observational studies comprising 13,540 patients were analyzed, including 1177 with CAE and 12,363 without CAE. Follow-up ranged from in-hospital assessment to 120 months. CAE was associated with a higher risk of recurrent myocardial infarction (RR, 1.96; 95% CI, 1.16-3.32; P = 0.022; I2 = 61.1%), corresponding to an estimated absolute excess of 58.6 events per 1000 patients and a descriptive number needed to harm of 17. For stroke, the prespecified Hartung-Knapp analysis yielded an RR of 2.40 (95% CI, 1.59-3.61), whereas conventional random-effects inference, used as the basis of interpretation, yielded an RR of 2.40 (95% CI, 1.08-5.31; P = 0.031). This estimate was based on 3 studies and was model-sensitive. CAE was not significantly associated with all-cause mortality, in-hospital mortality, cardiac death, repeat revascularization, or MACE. Stent thrombosis was not pooled because only 2 studies provided estimable stent-exposed comparisons. Bayesian analyses supported the recurrent myocardial infarction finding.
CONCLUSIONS: Among patients presenting with ACS, CAE identifies a higher-risk ischemic phenotype, with the most consistent association observed for recurrent myocardial infarction. Prospective studies are needed to define CAE-specific risk stratification and treatment strategies.
OBJECTIVES: To evaluate clinical outcomes among patients with versus without CAE presenting with ACS.
METHODS: PubMed/MEDLINE and Scopus were searched from inception to April 2026 for studies comparing ACS patients with versus without CAE. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models with restricted maximum likelihood estimation and Hartung-Knapp adjustment. Subgroup, leave-one-out, and Bayesian random-effects analyses were performed to assess robustness.
RESULTS: Twelve observational studies comprising 13,540 patients were analyzed, including 1177 with CAE and 12,363 without CAE. Follow-up ranged from in-hospital assessment to 120 months. CAE was associated with a higher risk of recurrent myocardial infarction (RR, 1.96; 95% CI, 1.16-3.32; P = 0.022; I2 = 61.1%), corresponding to an estimated absolute excess of 58.6 events per 1000 patients and a descriptive number needed to harm of 17. For stroke, the prespecified Hartung-Knapp analysis yielded an RR of 2.40 (95% CI, 1.59-3.61), whereas conventional random-effects inference, used as the basis of interpretation, yielded an RR of 2.40 (95% CI, 1.08-5.31; P = 0.031). This estimate was based on 3 studies and was model-sensitive. CAE was not significantly associated with all-cause mortality, in-hospital mortality, cardiac death, repeat revascularization, or MACE. Stent thrombosis was not pooled because only 2 studies provided estimable stent-exposed comparisons. Bayesian analyses supported the recurrent myocardial infarction finding.
CONCLUSIONS: Among patients presenting with ACS, CAE identifies a higher-risk ischemic phenotype, with the most consistent association observed for recurrent myocardial infarction. Prospective studies are needed to define CAE-specific risk stratification and treatment strategies.