THE NATURAL-HISTORY OF ANEURYSMAL CORONARY-ARTERY DISEASE

Objective-To assess the contribution of coronary artery ectasia, eithe r isolated or in association with obstructive coronary artery disease, to morbidity and mortality from ischaemic heart disease. Design-A ret rospective study of patients undergoing coronary arteriography at a te rtiary cardiac centre. Patients and methods-The epidemiological, clini cal, arteriographic, and follow up characteristics of three groups of patients were examined: group A, 172 patients with coronary artery ect asia and coexisting significant coronary artery disease; group B, 31 p atients with coronary artery ectasia only; group C, 165 patients with significant coronary artery disease but without ectasia, matched for s ex and age with group A. Resuls-Group A patients had a similar inciden ce of a previous myocardial infarction to group C patients (61.6% v 64 .2%), exercise performance, severity of obstructive lesions (CASS scor e 2.19 v 2.14), and similar distribution of diseased vessels. At follo w up of approximately two years they experienced a similar incidence o f unstable angina (7.5% v 4.4%) and myocardial infarction plus cardiac death (4.9% v 6.1%. They underwent bypass surgery with similar freque ncy (39% v 42%) but there was a lower frequency of percutaneous transl uminal coronary angioplasty (5.8% v 17%, P< 0.01). Patients with coron ary ectasia (group B) had a lower incidence of a previous myocardial i nfarction (38.7%, 12/31, P < 0.05) than the two other groups. The infa rct in all cases was related to an ectatic artery. Their exercise perf ormance and ejection fraction (9 (SD 3) minutes and 56.5(9)%) were hig her (P < 0.01) than group A (5 (2) minutes, 48.3(10)%) and group C (5. 3 (2) minutes, 49.3(10)%). Group B had no myocardial infarctions, card iac death, surgery, or intervention at follow up; 4.4% (5/115) develop ed unstable angina. The incidence of angina at study entry was similar in all three groups (38.7-49.7%). Conclusions- Coronary artery ectasi a does not confer added risk in patients with coexisting obstructive C oronary artery disease. Although there is a measurable incidence of pr evious myocardial infarction, patients with pure ectasia have a good p rognosis. The wisdom of giving oral anticoagulants to such patients is questioned.