Originala Articles Korean Circulation J 2000;3010:1205-1212 관상동맥확장증의임상및관상동맥조영술상특성 김원 1 정명호 2 김계훈 1 김건형 1 이승욱 1 김남호 1 안영근 1 조정관 2 박종춘 2 강정채 2 Clinical and Angiographic Characteristics of Coronary Artery Ectasia Weon Kim, MD 1, Myung Ho Jeong, MD 2, Kye Hun Kim, MD 1, Kun Hyung Kim, MD 1, Seung Wook Lee, MD 1, Nam Ho Kim, MD 1, Young Keun Ahn, MD 1, Jeong Gwan Cho, MD 2, Jong Chun Park, MD 2 and Jung Chaee Kang, MD 2 1 The Heart Center, Chonnam National University Hospital, Kwangju, 2 The Research Institute of Medical Sciences, Chonnam National University, Kwangju, Korea ABSTRACT BackgroundCoronary artery ectasia is an abnormal enlargement of coronary artery and infrequently associated with acute coronary syndrome. The prognosis, treatment, and etiology of this disease remain unclear. Method Sixtyone patients 35 male and 26 female, 5311.0 years out of 4,694 patients who underwent diagnostic coronary angiography at Chonnam National University Hospital between January 1996 and March 1999, and diagnosed as isolated coronary artery dilatatation without significant stenosis, were analyzed retrospectively. ResultsThe incidence of coronary artery ectasia on the coronary angiography was 1.29%. Smoking was the most frequently associated risk factor. Clinical diagnosis was 16 26.2% cases of stable angina, 29 47.5% unstable angina, 9 14.7% acute myocardial infarction, 5 8.1% old myocardial infarction, and 2 3.3% variant angina. Right coronary artery was the most frequent involved artery 42.5%. Type according to Markins classification was 63.9%. Proximal part of coronary artery was the most common involved arterial segment. Aspirin 78.7%, calcium antagonist 73.8%, nitrate 29.5% and -blocker 12% were used. During clinical follow-up of 12 10.5 months, there were no major cardiac event in all patients. ConclusionThe incidence of the coronary artery ectasia in Korean patients was relatively rare, and long-term prognosis was good. Korean Circulation J 2000; 30 10:1205-1212 KEY WORDSCoronary ectasia Coronary angiograpy Prognosis. 서 론 1205
대상및방법 관찰대상 관상동맥확장증의정의및분류 방법 Fig. 1. Markis classfication for coronary artery ectasia. Reprinted Sorrell VL et al. Current knowledge and significance of coronary artery ectasia. Clin Cardiol 199821157-60. 1206 Korean Circulation J 2000;3010:1205-1212
통계 결과 관상동맥확장증의유병률 대상환자의임상적특징 Table 2. Clinical characteristics of the patients No % Fig. 2. A patient presented with acute inferior myocardial infarction. Coronary angiography revealed diffuse coronary ectasia type I according to Markis classification with intracoronary thrombus in the distal right coronary artery white arrow. No significant change demonstrated on 6-month follow-up coronary angiography. Table 1. Classification of coronary artery ectasia Diffuse ectasia involving two or more vessel Diffuse ectasia involving one vessel and localized ectasia involving another Diffuse ectasia involving one vessel only Localized or segmental ectasia only Age years 5311.0 Sex Male 35 57.3 Female 26 43.7 Clinical diagnosis Stable angina 16 26.2 Unstable angina 29 47.5 Acute myocardial infarction 9 14.7 Old myocardial infarction 5 8.1 Variant angina 2 3.3 Risk factors Smoking 39 50.6 Hypertension 27 35.0 Hypercholesterolemia 15 19.5 Diabetes mellitus 8 10.4 Family history Hypertension 8 13.1 Ischemic heart disease 6 9.8 1207
관상동맥조영술소견 약물치료 추적관찰 1208 Table 3. Angiographic characteristics of the patients Markis classification 고 안 No % Type 39 63.9 Type 8 13.1 Type 11 18.0 Type 2 3.3 Involved artery n120 Left anterior descending artery 36 30.0 Left circumflex artery 33 27.5 Right coronary artery 51 42.5 Table 4. Results of medical treatment and clinical follow-up Medical treatment Number % Aspirin 48 78.7 Calcium antagonist 45 73.8 Nitrate 18 29.5 Angiotension converting enzayme inhibitor 12 20.0 Beta-blocker 7 12.0 Anti-platelet agent 13 21.0 Clinical follow-up Asymptomatic 45 80.3 Angina pectoris 6 10.7 Atypical chest pain 5 8.9 Acute myocardial infarction 0 0.0 Cardiac death 0 0.0 Korean Circulation J 2000;3010:1205-1212
1209
1210 Korean Circulation J 2000;3010:1205-1212
연구목적 : 요약 방법 : 결과 : 결론 : 중심단어 REFERENCES 1) Swaye PS, Fisher LD, Litwon P, Vingela PA, Judkins MP, Kemp HG. Aneurysmal coronary artery disease. Circulation 198367134-8. 2) Markis JE, Joffe CD, Cohn PF, Feen DJ, Hermann MV, Gorlin R. Clinical significance of coronary arterial ectasia. Am J Cardiol 197637217-22. 3) Swanton RH, Thomas MC, Coltart DJ, Jenkins BS, Webb- Peple MM, Williams BT. Coronary artery ectasiaa variant of occlusive coronary arteriosclerosis. Br Heart J 197840393-400. 4) Befeler B, Aranda JM, Embi A, Mullin EL, El-Sherif N, Lazzara R. Coronary artery aneurysm. Study of their etiology, clinical course and effect on left ventricular function and prognosis. Am J Med 197762597-607. 5) CASS Principal Investigators and their Associates. Coronary Artery Surgery Study CASS: a randomized trial of coronary artery bypass surgery survival data. Circulation 198368939-50. 6) Hartnell GG, Parnell BM, Pride RB. Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients. Br Heart J 198554392-5. 7) Demopoulous VP, Olympios CD, Fakiolas CN, Pissimissis EG, Economides NM, Adamopolou EA, et al. The natural history of aneurysmal coronary artery disease. Heart 199778136-41. 8) Williams MJ, Stewart RA. Coronary artery ectasia: local pathology or diffuse disease? Cathet Cardiovasc Diagn 199433116-9. 9) Falsetti HL, Carroll RJ. Coronary artery aneurysm. A review of the literature with a report of 11 new cases. Chest 197669 630-36. 10) Daoud AS, Pankin D, Tulgan H. Aneurysms of the coronary arteryreport of ten cases and review of literature. Am J Cardiol 196311228-37. 11) Holainger DR, Osmundson PJ, Edwards JE. The heart in periarteritis nodosa. Circulation 196225610-8. 12) Konecke LL, Spitzer S, Manson D. Traumatic aneurysm of the left coronary artery. Am J Cardiol 197127221-3. 13) Theron HDT, Kleynhans P, Marx J, Marks DS. Successful coronary reperfusion with intracoronary streptokinase in a patient with coronary ectasia. SAMTl 198772502-3. 14) Bhargava M, Kaul UA, Bhat A, Tyagi S, Khalilullah M. Prevalence and clinical significance of coronary artery ectasia an angiographic study. Indian Heart J 198941 284-7. 15) Tanveer S, Smith DW, Alimurung BN, Rab R, King SB. Thrombolytic therapy in coronary ectasia and acute myocardial infarction. Am Heart J 199011995-7. 16) Mabuchi H, Michishita I, Sakai Y, Ikawa T, Genda A, Takeda R, et al. Coronary ectasia in a homozygous patient 1211
with familial hypercholesterolemia. Atherosclerosis 1986 5943-6. 17) Huikuri HV, Mallon SM, Myerburg RJ. Cardiac arrest due to spontaneous coronary artery dissection in a patient with coronary ectasia. A case report. Angiology 1991 41148-51. 18) Tomaru A, Takigawa K, Kagawa N, Suzuki Y, Sue H, Arai T, et al. Coroanry artery ectasiaa case report and literature review. Angiology 199345415-19. 19) Takahashi K, Ohyanagi M, Ikeoka K, Tateishi J, Iwasaki T. Clinical course of patients with coronary ectasia. Cardiology 199991145-9. 20) Sorrell VL, Davis MJ, Bove AA. Origins of coroanry artery ectasia. Lancet 1996347136-7. 21) Vanhoutte PM. Endothelium and control of vascular function. Hypertension 198913658-67. 22) Lange RL, Reid MS, Tresch DD, Keelan MH, Bernhard VM. Nonatheromatous ischemic heart disease following withdrawal from chronic industrial nitroglycerin exposure. Circulation 197226666-78. 23) England GF. Herbicides and coronary artery ectasia letter. M J Aust 198168260. 24) International Agency for Research on Cancer Report. 1978 781-47. 25) Bernard F, Revel F, Monsegu J, Duriez P, Langlade S, Ollivier JP, et al. Coronary vessel ectasia: coronary artery disease with a high thromboembolic risk. Ann Cardiol Angiol 199847160-4. 26) Cross SJ, Lee HS, Kenmure AC, Jennings KP. Coronary artery ectasia: is it associated with myocardial ischemia and infarction? Scott Med J 1993;3828-9. 27) Sharifi M, Murdock D, Engelmeier R, Loogemann T, Hoffmann MT, Olson K, et al. Simultaneous presence of a large coronary aneurysm and ectasia in a young patient with myocardial infarction. Angiology 1997481001-5. 28) Lierde J, Vrolix M, Sionis D, Geest H, Piessens J. Lack of evidence for small vessel disease in a patient with slow dye progression in the coronary arteries. Cathet Cardiovasc Diagn 1991 23117-20. 29) Kruger D, Stierle U, Herrmann G, Simon R, Sheikhzadh A. Exerciseinduced myocardial ischemia in isolated coronary artery ectasia and aneurysm dilated coronaropathy. J Am Coll Cardiol 1999341461-70. 30) Davies MJ. Coronary aretry remodelling and the assessment of stenosis by pathologists. Histopathology 1998 33497-500. 31) Sudhir K, Ports TA, Amidon TM, Goldberger JJ, Bhuahan Y, Kane JP, et al. Increased prevalence of coronary ectasia in heterozygous familial hypercholesterolemia. Circulation 1995911375-80. 32) Kajinami K, Kasashima S, Oda Y, Koizumi J, Katsuda S, Mabuchi H, et al. Coronary ectasia in familial hypercholesterolemia: histopathologic study regarding matrix metalloproteinase. Mod Pathol 1999121174-80. 33) Bove AA, Vlietstra RE. Spasm in ectatic coronary arteries. Mayo Clin Proc 198560822-6. 34) Suzuki H, Takeyama Y, Hamazaki Y, Namiki A, Koba S. Coronary spasm in patients with coronary ectasia. Cathet Cardiovasc Diagn 1994321-7. 35) Illia R, Kafri C, Carmel S, Goldfarb B, Gueron M, Battler A, et al. Angiographic follow-up of coronary artery ectasia. Cardiology 199586388-90. 36) Farto AP, Mesquita A, Silva JA, Seabra-Gomes R. Coronary artery ectasia: clinical and angiographic characteristics and prognosis. Rev Port Cardiol 199312305-10. 37) Sorrell VL, Davis MJ, Bove AA. Current knowledge and significance of coronary artery ectasia: A chronologic review of the literature, recommendations for treatment, possible etiologies, and future considerations. Clin Cardiol 199821157-60. 38) Hart JJ, Joslin CG. Coronary artery ectasia. Kans Med 1998986-9. 39) Sanyal S, Caccavo N. Is nitroglycerine detrimental in patients with coronary artery ectasia? A case report. Tex Heart Inst J 199825140-4. 1212 Korean Circulation J 2000;3010:1205-1212