Vol. 7, Issue 2, Part B (2025)

Background: Coronary artery ectasia (CAE), defined as dilatation ≥1.5 times the adjacent normal coronary segment, is an uncommon angiographic finding with reported prevalence of 0.3-4.9%. Although often considered non-obstructive, CAE carries significant thrombotic risk and adverse outcomes, highlighting the need for reliable non-invasive predictors.

Objectives: This research aims to research the risk factors and non-invasive predictors of CAE among the cases presented or manifested by coronary artery disease (CAD).

Methods: This prospective cohort was conducted at Banha University and Al-Matria Teaching Hospital including 270 cases, 67 controls and 203 cases with acute coronary syndrome (ACS) undergoing coronary angiography were divided into: Group 1 (CAE, n=96, subgroups 1a obstructive n=20, 1b non-obstructive n=76), Group 2 (obstructive CAD, n=107), and Group 3 (controls with normal coronaries, n=67). Data collection included demographics, cardiovascular risk factors, laboratory markers (lipids, creatinine, ALT, AST, Hb), cardiac enzymes, echocardiography (LVEF), and angiographic parameters.

Results: Age and sex were comparable across groups, but hypertension (75.0%) and diabetes mellitus (66.7%) were significantly more frequent in CAE compared with CAD (59.8%, 57.0%) and controls (46.3%, 32.8%) (p≤0.001). ACS presentation varied (p<0.001): unstable angina predominated in controls (100%), non-ST elevation myocardial infarction (NSTEMI) in CAE (37.5%) and CAD (44.9%), while STEMI was largely confined to CAD (32.7%). CAE cases had severe dyslipidemia: cholesterol 296.5 vs 214.5 vs 157.5 mg/dL, triglycerides 231.0 vs 156.0 vs 98.5 mg/dL, LDL 207.5 vs 144.0 vs 97.0 mg/dL, LDL/HDL 6.4 vs 3.6 vs 2.1 (all p<0.001). Cardiac enzymes were highest in CAD, lowest in controls, with CAE in between, LVEF was lowest in CAD (50%) and highest in controls (59%) (p<0.001). Angiographically, CAE showed single-vessel predominance (84.4%) with RCA (39.6%) and LCX (21.9%) as most affected (p<0.001). Obstructive CAE was linked to STEMI (55.0%), longer ectasia (3.8 vs 2.3 cm), more ectatic sites, and thrombus (35.0% vs 0%, p≤0.001).

Conclusions: CAE is more often associated with unstable angina, whereas obstructive CAD commonly presents with STEMI and NSTEMI. CAE cases exhibit marked metabolic abnormalities as opposed to CAD, and obstructive ectasia cases show greater STEMI prevalence, diffuse and longer ectatic segments, more thrombus, and higher ejection fraction. The right coronary artery is the vessel most frequently involved.