Management and Outcomes of Coronary Artery Aneurysms: A Patient-Level Systematic Review.

Abstract

Background: Data are lacking to guide standardized management of coronary artery aneurysms (CAAs). We sought to analyze the available evidence in a quantitative manner.

Methods: An electronic search identified 431 case reports or case series on CAA, comprising 488 patients. Patient-level data were extracted. Subgroups of CAA with fistulous connections (CAAF) and CAA 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) versus CAAF: 45.2% (52/115); P < 0.01]. The median largest aneurysm diameter was higher in the CAAF group [CAAO: 3.0 (1.5-5.0) cm versus CAAF: 5.0 (3.0-7.0) cm; P < 0.01], and rupture was more frequently observed in the CAAF group [CAAO: 3.1% (11/353) versus CAAF: 13.8% (16/116); P < 0.01]. For any given diameter, CAAF had a higher risk of rupture compared with CAAO. Surgery was the most common management strategy, particularly in patients with CAAF [CAAO: 50.9% (189/371) versus CAAF: 75.2% (88/117); P < 0.01]. The Kaplan-Meier analysis showed a trend toward more favorable survival in CAAF. The hazard of mortality was associated with aneurysm diameter in both subsets but was higher in the CAAO group independent of surgical versus interventional management.

Conclusions: 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 the presence or absence of a fistula; however, both surgical and interventional modes of management result in similar survival.