Abstract
Coronary artery ectasia is found in 3 to 8% of patient's undergoing angiography and
may sometimes induce acute myocardial infarction. Some articles reported a recurrence
of acute coronary syndrome (ACS) in the presence of coronary artery ectasia (CAE).
Our study aims to summarize the latest evidence on whether the use of anticoagulant
in addition to SAPT/DAPT (single antiplatelet/dual antiplatelet) treating ACS with
CAE patients is necessary. Since the trials concerning our objectives were scarce,
we pooled case reports/series. We performed a comprehensive search on case reports/series
on coronary artery ectasia that presented with acute coronary syndrome published until
March 2019. We collected 13 cases from 11 reports. Out of 13 patients, 5 (38.5%) took
DAPT only without anticoagulant and 8 (61.5%) took anticoagulant ± DAPT. Three out
of five (60%) who took DAPT only, experienced recurrences at 1st and 2nd months' follow-up.
The other two (40%) was uneventful at a mean of two months' follow-up. Eight patients
who took anticoagulant were uneventful for a mean of 8.4 months. Those who took anticoagulant
were at lower risk of experiencing ACS recurrence (p = 0.035). Two of the patients who experienced recurrence became 6 and 12 months free
after optimal anticoagulation. The author of this study proposed that anticoagulant
must be considered should SAPT/DAPT failed to provide adequate protection to the recurrence
of ACS, especially in CAE patients who did not have other obvious stenotic lesions.
However, the evidence is weak since this study only pooled case reports/series.
Keywords acute coronary syndrome - coronary artery ectasia - recurrence - antiplatelet - anticoagulant
- antithrombotic - triple therapy
