Daler Rahimov, Nayeem Nasher, Danial Ahmad, Rohinton J Morris, Anjali Upadhyaya, Colin Yost, Daniella Wong, Preeyal Patel, Alec Vishnevsky, Nicholas J Ruggiero, John W Entwistle, Vakhtang Tchantchaleishvili
{"title":"Management and Outcomes of Coronary Artery Aneurysms: A Patient-level Systematic Review.","authors":"Daler Rahimov, Nayeem Nasher, Danial Ahmad, Rohinton J Morris, Anjali Upadhyaya, Colin Yost, Daniella Wong, Preeyal Patel, Alec Vishnevsky, Nicholas J Ruggiero, John W Entwistle, Vakhtang Tchantchaleishvili","doi":"10.1097/HPC.0000000000000381","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Data are lacking to guide standardized management of coronary artery aneurysms (CAA). We sought to analyze the available evidence in a quantitative manner.</p><p><strong>Methods: </strong>Electronic search identified 431 case reports or case series on CAA, comprising 488 patients. Patient-level data were extracted. Subgroups with (CAAF) and without fistulous connections (CAAO) were analyzed separately.</p><p><strong>Results: </strong>Fistulous connection was present in 24.0% (117/488) of patients with CAA. Angina was a presenting symptom in 64.7% (301/465), with higher preponderance in the CAAO group [CAAO: 71.1 % (249/350) vs CAAF: 45.2% (52/115), p<0.01). Median largest aneurysm diameter was higher in the CAAF group [CAAO: 3.0 [1.5-5.0] cm vs CAAF: 5.0 [3.0-7.0], p<0.01], and rupture was more frequently observed in the CAAF group [CAAO: 3.1% (11/353) vs CAAF: 13.8% (16/116), p<0.01]. For any given diameter, CAAF had a higher risk of rupture compared to CAAO. Surgery was the most common management strategy, particularly in patients with CAAF [CAAO: 50.9% (189/371) vs CAAF: 75.2% (88/117), p<0.01]. Kaplan-Meier analysis showed a trend toward more favorable survival in CAAF. Hazard of mortality was associated with aneurysm diameter in both subsets but was higher in the CAAO group independent of surgical vs interventional management.</p><p><strong>Conclusion: </strong>CAAF appears to have a higher risk of rupture but may be associated with better survival than CAAO. Management for patients with CAA differs based on presence or absence of fistula, however, both surgical and interventional mode of management result in similar survival.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Pathways in Cardiology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/HPC.0000000000000381","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Data are lacking to guide standardized management of coronary artery aneurysms (CAA). We sought to analyze the available evidence in a quantitative manner.
Methods: Electronic search identified 431 case reports or case series on CAA, comprising 488 patients. Patient-level data were extracted. Subgroups with (CAAF) and without fistulous connections (CAAO) were analyzed separately.
Results: Fistulous connection was present in 24.0% (117/488) of patients with CAA. Angina was a presenting symptom in 64.7% (301/465), with higher preponderance in the CAAO group [CAAO: 71.1 % (249/350) vs CAAF: 45.2% (52/115), p<0.01). Median largest aneurysm diameter was higher in the CAAF group [CAAO: 3.0 [1.5-5.0] cm vs CAAF: 5.0 [3.0-7.0], p<0.01], and rupture was more frequently observed in the CAAF group [CAAO: 3.1% (11/353) vs CAAF: 13.8% (16/116), p<0.01]. For any given diameter, CAAF had a higher risk of rupture compared to CAAO. Surgery was the most common management strategy, particularly in patients with CAAF [CAAO: 50.9% (189/371) vs CAAF: 75.2% (88/117), p<0.01]. Kaplan-Meier analysis showed a trend toward more favorable survival in CAAF. Hazard of mortality was associated with aneurysm diameter in both subsets but was higher in the CAAO group independent of surgical vs interventional management.
Conclusion: CAAF appears to have a higher risk of rupture but may be associated with better survival than CAAO. Management for patients with CAA differs based on presence or absence of fistula, however, both surgical and interventional mode of management result in similar survival.
期刊介绍：
Critical Pathways in Cardiology provides a single source for the diagnostic and therapeutic protocols in use at hospitals worldwide for patients with cardiac disorders. The Journal presents critical pathways for specific diagnoses—complete with evidence-based rationales—and also publishes studies of these protocols" effectiveness.
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