| Purpose: This study aimed to analyze two different phenotypes of coronary aneurysmal dilatation（localized CAE and diffuse CAE）by retrospectively analyzing the clinical data of 196 patients with a definitive diagnosis of ACS and CAE and the occurrence of adverse events during long-term follow-up.and its subgroups（criminal vessels with diffuse CAE and culprit vessels with localized CAE）clinical features,adverse events and risk factors.Method: 196 patients who were diagnosed with acute coronary syndrome（ACS）at the First Hospital of Jilin University from January 2015 to December2016 and confirmed as coronary aneurysm ectasia（CAE）by coronary angiography enrolled in this study.The general clinical data,admission diagnosis,imaging data,procedure data,long-term medication after discharge,and adverse events during the follow-up period were collected.SPSS 26.0 software was used for statistical analysis,the dichotomous variables were analyzed by chi-square test and Log-rank test,the measurement data were analyzed by T test or nonparametric test,and the Kaplan-Meier analysis method was used to draw the survival curves of different groups.COX regression analysis identified independent risk factors for poor prognosis in ACS patients with CAE and their subgroups.result:（1）Basic characteristics of patients with ACS combined with CAE:A total of 196 patients were included in this study,of which 77.55%（152 cases）were male and 22.45%（44 cases）were female.Patients with diffuse expansion accounted for 71.94%（141 cases）,and patients with limited expansion accounted for 28.06%（55 cases）.The patients with hypertension were 65.31%（128 cases）,23.47%（46 cases）with diabetes,61.22%（120 cases）with hyperlipidemia,and61.73%（121 cases）with smoking history.Patients with a family history of coronary heart disease accounted for 5.61%（11 cases）.Among the patients admitted to hospital,STEMI accounted for 51.02%（100 cases）,NSTEMI was21.43%（42 cases）,and UA was 27.55%（54 cases）.A total of 258 dilated vessels were observed in the 196 enrolled patients,of which the most susceptible vessel was RCA,accounting for 53.49%（138）of the total dilated vessels,followed by LCX（23.26%（60）and LAD（19.77%）（51）.location）,and the least involvement was LM,only 3.4%（9 locations）.（2）The prognosis,survival and related risk factors of ACS combined with CAE: A total of 66 patients（33.67%）were tracked to have adverse events during the median follow-up of 72 months.Univariate analysis showed that there were two differences between diffuse CAE and localized CAE.The incidence of postoperative adverse events of phenotypes is different,and the COX regression model analysis results showed that the risk of MACE in ACS complicated with diffuse CAE was significantly higher than that in localized CAE（HR: 2.154,95%CI: 1.127-4.117,P= 0.02）.After adjusting for other covariates,it was still concluded that diffuse CAE was an independent risk factor for poor prognosis in patients with ACS complicated with CAE（HR: 2.154,95% CI: 1.087-4.267,P=0.028）.Blood fraction（LVEF）decreased（B:-0.051,HR: 0.951,95% CI:0.918-0.985,P=0.005）,left main with three-vessel disease（HR 3.374,CI 95%:1.175-9.685,P= 0.034）,left main trunk combined with two-vessel disease（HR6.208,Cl 95%: 1.074-35.896,P=0.041）were independent risk factors for MACE in patients with ACS combined with CAE,while aspirin,clopidogrel,β-blocker,ACEI/ARB drugs had a protective trend on the occurrence of adverse events,but the difference was not statistically significant（P>0.05）.（3）Subgroup analysis: A total of 121 patients were screened for ACS patients with dilated vessels as the culprit.RCA was the most susceptible location for tumor-like dilatation.This advantage was manifested in the diffuse CAE group.It was more prominent（80.23% VS 54.29%,P<0.05）,and diffuse CAE was more inclined to ST-segment elevation myocardial infarction（58.14%VS 48.57%,P=0.056）in terms of admission ECG diagnosis.The frequency of thrombectomy in the diffuse CAE group was also higher than that in the localized CAE group,but the difference did not reach statistical significance（19.77% VS5.71%,P=0.054）.In the diffuse CAE group,more ACEI/ARB drugs were used,but the difference did not reach statistical significance（56.98% VS 40%,P=0.090）.We can see from the survival curve that the risk of MACE and nonfatal MI in the diffuse CAE group were higher than those in the localized CAE group,but the difference did not reach statistical significance（Log-rank,P>0.05）.There was no significant difference in cardiac death.inconclusion:（1）The incidence of coronary aneurysm-like dilatation is low,and it is more common in male.Diffuse dilatation is more common than localized dilatation,and it is most likely to involve RCA.（2）The results of this study suggest that patients with acute coronary syndrome with diffuse coronary dilatation have an increased risk of major adverse cardiovascular events compared with patients with limited dilatation.（3）Decreased ejection fraction and left main trunk combined with multivessel disease are independent risk factors for poor prognosis in acute coronary syndrome combined with coronary aneurysm dilatation.（4）The risk of adverse cardiovascular events in patients with ACS culprit vessels complicated with diffuse dilatation was higher than that in patients with limited dilatation,but there was no statistical significance. |
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