FREQUENCY OF CORONARY ARTERY ECTASIA AS A CAUSE OF ACUTE CORONARY

SYNDROME IN PATIENTS PRESENTING IN JINNAH HOSPITAL LAHORE

Madiha Ilyas, Noor Dastgir, Ahmad Muqeet, Inam ur Rehman

Madiha Ilyas MBBS, FCPS (Cardiology)

Allama Iqbal Medical College, Jinnah Hospital Lahore

Email: madihailyas73947@gmail.com

Phone# 03328375502

Noor Dastgir MBBS , MRCP, FCPS(Cardiology)

Assistant Professor, Department of Cardiology

Allama Iqbal Medical College, Jinnah Hospital Lahore

Email: noordastgir@gmail.com

Phone# 03215555189

Ahmed Muqeet MBBS, FCPS (Cardiology)

Assistant Professor, Department of Cardiology

Allama Iqbal Medical College, Jinnah Hospital Lahore

Email: ahmed.muqeet@gmail.com

Phone# 03338468890

Inam ur Rehman MBBS, FCPS (Cardiology)

Allama Iqbal Medical College, Jinnah Hospital Lahore

Email: dr.inam977@gmail.com

Phone# 03133730630
DISCLOSURE

All the authors hereby disclose that they don’t have any potential conflict of interest to
mention.
 FREQUENCY OF CORONARY ARTERY ECTASIA AS A CAUSE OF ACUTE CORONARY

SYNDROME IN PATIENTS PRESENTING IN JINNAH HOSPITAL LAHORE

Abstract:

Objective: Coronary artery ectasia is a pathology of vessels that is rarely found in patients of acute coronary

syndrome who undergo angiography. It is identified when vessels are abnormally dilated leading to slow flow

of blood across the coronary arteries.Coronary thrombosis in dilated vessels is the primary cause of acute

coronary syndrome.As coronary ectasia is a frequent cause of myocardial ischemia with normal coronary

artery calliber , this study was done with the objective to find out the frequency of patients with acute coronary

syndrome having coronary artery ectasia as a sole cause.

Methodology:This study involved 139 patients over 6 months’ period, with clinical confirmation of acute

coronary syndrome,who underwent coronary angiography. The frequency of coronary artery ectasia was

classified according to gender and the defined age groups.

Results: Incidence of coronary artery ectasia was 1.4% (n=2) in patients with acute coronary syndrome who

underwent coronary angiography in cardiology department of Jinnah hospital Lahore.

Conclusion: Our study inferred that coronary artery ectasia is a rare and infrequent cause of acute coronary

syndrome in patients presenting in Jinnah hospital Lahore.

Key words

Coronary Artery Ectasia, Acute Myocardial Infarction, Acute Coronary Syndrome.

Introduction:

According to the definition coronary artery ectasia is characterized by a diffuse coronary artery dilation

with the diameter 1.5 times greater than adjacent normal (disease free) segment of the artery seen in coronary

angiography (1,2,3). Ectasia occurs due to endothelial dysfunction and is responsible for sluggish blood flow in
coronary arteries leading to effort angina and myocardial infarction.This sluggish or turbulent flow of blood

leads to the formation of thrombi or micro emboli dissemination to distal segments, causing occlusion of the

vessel leading to signs and symptoms of acute coronary syndrome(4).

Though the main cause of acute coronary syndrome is obstructive lesion in coronary arteries, coronary

artery ectasia is also not an uncommon cause in clinical practice. The incidence of coronary artery ectasia

extends from 1.5 to 5.0% in the reviewed international literature (4).

Risk factors like dyslipidemia, smoking, hypertension and diabetes are well recognized for causing

atherosclerotic coronary artery disease leading to acute coronary syndrome (5) but coronary ectasia as a risk

factor for coronary artery disease is not well established.

Therefore it was intended to find out the frequency of cases of acute myocardial infarction due to

coronary artery ectasia, so that preventive measures like intense risk factor modification, administration of anti-

platelets and statins may be carried out timely to reduce the burden of acute coronary syndrome caused by

ectasia in our nation.

Methodology:

A Cross Sectional Study was done over 6 months’ duration (June 20, 2018 to December 20, 2018).A

sample size comprising of 139 patients was estimated with 5% margin of error, 95% confidence interval,

80%power, assuming 10% coronary artery ectasia frequency (4).The study included patients with acute

coronary syndrome undergoing coronary angiography within 12 hours of symptoms onset. Exclusion criteria

were patients with acute myocardial infarction already undergone coronary intervention either percutaneous or

surgical intervention, patients with obstructive coronary artery diseaseshown in coronary angiography and

patients of chronic kidney disease defined as creatinine > 2.0 mg/dl.

The study got approval from the ethical review committee of the institution. All patients were treated

according to the standard hospital protocols. Their coronary angiography was done which was evaluated for
evidence of coronary artery ectasia as per operational definition and demographic data depictingpresence or

absence of ectasia were noted down on a pre-designed Performa.

Data was put into the Statistical Package for Social Sciences (SPSS) 16. Continuous variables were

narrated as mean and standard deviation. Categorical variable were reported as frequencies and percentages.

Data stratification was done for age and sex by chi-square test taking P-value ≤ 0.05 as significant.

Results:

In our study,139 patients with acute coronary syndrome were subjected to coronary angiography and

Coronary artery ectasia distribution of the patients showed that 1.4% (n= 2) had coronary artery ectasia (figure

1) and 98.6% (n=137) had no ecstatic changes in their coronary arteries.

Stratification of coronary artery ectasia with respect to age showed that it is more frequent in group of

20-40 years age than in age group of 41-80 years (Table no.1).

Table no.1 Stratification of coronary artery ectasia with respect to age (n=139)

Age Group CAE (count %) Total p-value

No Yes

20-40 years 9 (6.5%) 2(1.4%) 11 (7.9%)

41-80 years 128 (92.1%) 0 (0.0%) 128 (92.1%) 0.001

139 (100%)
Total 137 (98.6%) 2 (1.4%)
Stratification with respect to gender showed that coronary artery ectasia is distributed equally in both men and

women (Table no. 2).

Table no. 2 Stratification of coronary artery ectasia with respect to gender (n=139)

Gender CAE (count %) Total p-value

No Yes

35(25.2%) 1 (0.7%) 36 (25.9%)

Male

102 (73.4%) 1 (0.7%) 103 (74.1%) 0.433

Female

Total 137 (98.6%) 2 (1.4%) 139 (100%)

Discussion:

Coronary artery ectasia is described as a diffuse dilation of the coronary arteries with diameter 1.5 times

wider than that of adjacent normal disease free segment of the artery seen in coronary angiography(1).Ectasia

occurs due to endothelial dysfunction due either to atherosclerosis connective tissue disorder or genetic cause

and is responsible for sluggish blood flow in coronary arteries with increased frequency of angina on exertion

and myocardial infarction(4).

Acute myocardial infarction also termed as heart attack, is mostly caused by hindrance of blood flow in

the artery supplying heart muscle, thus making that area deprived of blood and oxygen leading to its necrosis.

This hindrance can be due to a blood clot or spasm in the epicardial artery supplying that area of myocardium.

The incidence of coronary artery ectasia, as reviewed in most of the international literature, ranges from

1.5 to 5.0%(1,2,3).

The current study showed that incidence of coronary artery ectasia in patients with acute coronary

syndrome was 1.4% (n=2).

There were more number of patients of acute coronary syndrome (independent of cause) in age group of

41-80 years i.e.92.1 % (n=128) than in age group of 20-40 years i.e.7.9 %( n=11) patients endorsing that old age

is an independent non modifiable risk factor of coronary artery disease. In this study, frequency of males with
coronary artery disease was higher 74.1 %( n=103) than frequency of females 25.9 %( n=36) as male gender

also is an independent risk factor of coronary artery disease.

In our study, only 2 cases were found to have coronary artery ectasia who were in 20-40 years age group

and there was no case of coronary artery ectasia in age group of 41-80 years.According to gender distribution

only 1 male and 1 female patient had coronary artery ectasia in this study.

In another study, it was found that occurrence of coronary artery ectasia was 4 times more in men than

in women endorsing male gender to be an independent non modifiable risk factor of coronary artery disease and

it was more frequent in people having risk factors of atherosclerotic heart disease such as smoking,

hypertension and diabetes (5).

Another study stated that Coronary artery ectasia was an infrequent disease that occurred in only 0.3-

4.9% of people of North America. Although this disease is commonly manifested in patients with

atherosclerotic coronary artery disease, it can also occur solely and in either case it causes cardiac problems. If

the disease is not treated timely, it can cause permanent damage to the myocardium. The coronary artery having

ectasia has increased tendency to develop weak points in the vessel wall or aneurysms that can get ruptured

leading to catastrophic consequences (5).

In our study done on patients of acute coronary syndrome presenting in Jinnah hospital Lahore,

frequency of ectasia as a sole cause of acute coronary syndrome is 1.4% which makes it an infrequent cause.

The limitations of study are that it is performed in a single centre and perhaps a bigger sample size or a

multicentered study may achieve better more comprehensive results and further work in future might be done in

this direction.

Conclusion:

Our study inferred that coronary artery ectasia is an infrequent cause of acute coronary syndrome in

patients who underwent coronary angiography presenting in cardiology department Jinnah hospital Lahore.

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