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[Coronary artery ectasia: clinical and angiographic characteristics and prognosis].

OBJECTIVE
To evaluate the incidence of coronary ectasia and its distribution by coronary vessels, natural history and follow-up in coronary artery disease patients.


DESIGN
Retrospective study from 1982 to 1985.


SETTING
Hemodynamics Cardiology Department of a Central Hospital.


PATIENTS
In 1100 patients with coronary artery disease, there were 40 patients, 39 men and 1 woman, with mean age of 53.98 +/- 7.49 years.


MATERIAL AND METHODS
Coronary ectasia was defined by CASS criteria as: Diameter of a vessel in the coronarography up to one and half times the diameter of a adjacent normal branch. In the clinical profile, both risk factors and clinical parameters such as angina or myocardial infarction were evaluated. The distribution of coronary ectasia by segments and vessels was also noted. In follow-up we analysed major cardiac events, as well as the need for by-pass surgery.


RESULTS
The incidence of coronary ectasia was 3.6%. Smoking was the most frequent risk factor. 42.5% of patients had anti-ischemic therapy and 87.5% has previous angina, 62.5% of whom had myocardial infarction. Angiographic findings showed only one ectatic coronary artery in 25 patients. Right coronary artery was the most frequent ectatic vessel (75%), and there was a higher prevalence of coronary ectasia in the proximal segments (p < 0.001). 33 patients had stenotic lesions associated to coronary ectasia. At a mean follow-up of 63.15 +/- 30.46 months, there were nine major cardiac events (one death, three myocardial infarctions and five new episodes of unstable angina), and eighteen patients underwent coronary by-pass surgery. There were no differences between "pure" ectatic and stenotic coronary associated groups, even in patients who needed bypass surgery.


CONCLUSIONS
These results confirmed the usual incidence of coronary ectasia, as well as the predominance of right coronary artery ectasia. Proximal segments were more frequently ectatic. Although "pure" coronary ectasia can be implicated in angina or myocardial infarction, we think that a worse prognosis depends on the association of stenotic coronary artery disease.