Long-Term Outcomes of Conservative Versus Invasive Approach of Coronary Aneurysm

Anthony Matta; Francisco Campelo-Parada; Vanessa Nader; Thibault Lhermusier; Frédéric Bouisset; Stéphanie Blanco; Meyer Elbaz; Jerome Roncalli; Didier Carrié

doi:10.31083/j.rcm2308281

Long-Term Outcomes of Conservative Versus Invasive Approach of Coronary Aneurysm

Rev Cardiovasc Med. 2022 Aug 10;23(8):281. doi: 10.31083/j.rcm2308281. eCollection 2022 Aug.

Authors

Anthony Matta^{1

2

3

4}, Francisco Campelo-Parada¹, Vanessa Nader^{1

3}, Thibault Lhermusier¹, Frédéric Bouisset¹, Stéphanie Blanco¹, Meyer Elbaz^{1

3}, Jerome Roncalli^{1

3}, Didier Carrié^{1

3}

Affiliations

¹ Department of Cardiology, Toulouse University Hospital (Hopital Rangeuil), 31400 Toulouse, France.
² Department of Cardiology, Centre Hospitalier Intercommunal Castres-Mazamet, 81108 Castres, France.
³ Faculty of Sciences, Paul-Sabatier Toulouse III University, 31062 Toulouse, France.
⁴ Faculty of Medicine, Holy Spirit University of Kaslik, 446 Jounieh, Lebanon.

Abstract

Introduction: Up to date, the management of coronary artery aneurysm (CAA) is not well defined and depends on local heart team decision. Data reported in literature are scarce and controversial. We aim to compare the long-term outcomes of different therapeutic strategies of CAA (medical vs percutaneous coronary intervention (PCI) vs coronary artery bypass graft(CABG)).

Materials and methods: A retrospective cohort study was conducted on 100 consecutive patients who underwent coronary angiography at Toulouse University Hospital, Toulouse France and fulfilled the diagnostic criteria of CAA. Coronary angiograms were reviewed, and all necessary data were collected. CAA was defined by a coronary dilation exceedingly at least 50% of reference coronary diameter.

Results: We identified 100 patients with CAA with a mean age of 67.9 $\pm$ 12 years. The left anterior descending coronary artery was most affected (36%). CAA is associated with significant coronary artery disease in 78% of cases. The incidence of major adverse cardiovascular and cerebrovascular events (MACCE) was 13% during a median follow-up period of 46.2 $\pm$ 24 months. A 53% of patients underwent PCI or CABG. The rate of MACCE was lower in CABG group (9.1%) compared to PCI (14.3%) and medical (12.8%) groups, but without reaching statistically significant level. Longitudinal aneurysm diameter was positively linked to MACCE [OR = 1.109, 95% CI (1.014-1.214), p = 0.024]. No benefits have been attributed to anticoagulant regimen over antiplatelet therapy.

Conclusions: In our retrospective observational study, there seems to be no significant differences in MACCE-free survival between all groups (Medical vs PCI vs CABG). Larger longitudinal aneurysm diameter was identified as a predictor of poor prognosis during follow-up.

Keywords: cardiac surgery; coronary artery aneurysm; coronary artery disease; medical; percutaneous coronary intervention.