Abstract
The literature on prevalence and outcomes of coronary artery aneurysm (CAA) in the United States (US) is limited.
To study the prevalence, outcomes, and trends of CAA.
Data from the national readmissions database (NRD) sample that constitutes 49.1% of the stratified sample of all hospitals in the US were analyzed for CAA among coronary angiography (CA) related hospitalizations for the years 2012–2018.
A total of 6,843,910 index CA related hospitalizations were recorded for the years 2012–2018 in the NRD (Mean age 64.37 ± 13.30 years' 38.6% females). Of these 9671 (0.141%) were CAA, 5092 (52.7%) without-ACS and 4579 (47.3%) with ACS [NSTEMI occurred in 2907(63.5%) and STEMI in 1672(36.5%)]. In-hospital mortality among CAA was comparable to those without-CAA on angiography (n-209,2.17% vs n = 175,120,2.56%;p = 0.08). CAA patients who presented with ACS vs those without ACS had higher mortality (n = 150,3.28%vsn = 60,1.16%;p < 0.001) cardiogenic shock 6.9%vs2%, ventricular arrythmias 9.2%vs5.2%, coronary dissection 58%vs42.7%, and need for mechanical circulatory support 7%vs2.7% respectively. Percutaneous coronary intervention (PCI) was performed among 45.2% patients; however, on coarsened exact matching of baseline characteristics, PCI had no association with mortality, patients (OR 1.22, 95%CI0.69–2.16, p = 0.49). The prevalence of CAA on CA trend towards increased mortality with ACS increased over the years 2012–2018 (linear p-trend <0.05). The 30-day readmissions rate were 13.8% (non-CAA) vs 4.6% (CAA) p = 0.001 predominantly cardiovascular causes (50.9%vs70.7%) and PCI on readmission (7.06%vs17.5%).
CAA is an uncommon anomaly noted on coronary angiography. The higher mortality in patients with ACS and increasing trend of CAA-ACS warrants more research.
Central Illustration. Graphical representation for the possible complications associated with coronary artery aneurysm patients with acute coronary syndrome. (Created with Biorender.com). [Display omitted]
•The prevalence of CAA was 14 per 10,000 coronary angiographies in NRD 2012-2018.•Patients with acute MI and CAA had higher mortality rates and higher need for mechanical circulatory support.•CAA trend increased over 2012-2018 as did the mortality in patients within ACS subgroup of CAA.•CAA patients had lower rates of 30-day readmissions, however, higher rates of PCI on readmission.•Half of the patients with CAA had associated spontaneous coronary artery dissection recorded in the hospitalization encounters.