Angiographic Characteristics of ST-Elevation Myocardial Infarction Patients With Infarct-related Coronary Artery Ectasia Undergoing Primary Percutaneous Coronary Intervention.

Coronary ectasia accounts for 0.3%-4.9% of patients undergoing coronary angiography. We conducted the present study to evaluate the angiographic characteristics of ST-elevation myocardial infarction (STEMI) patients with infarct-related coronary artery ectasia (IRAE) undergoing primary percutaneous coronary intervention. We evaluated 667 STEMI patients who were divided into 2 groups of IRAE (n = 81) and non-IRAE (n = 568). Preprocedural thrombolysis in myocardial infarction (TIMI) flow grade, postprocedural TIMI flow grade, thrombus burden grade, and TIMI frame count were then evaluated. In adjusted analysis, fewer patients with IRAE had open (TIMI flow grade II or III) infarct-related arteries before the primary percutaneous coronary intervention (7.4% vs. 27.5%; odds ratio: 4.522; 95% confidence interval, 1.924-10.628; P = 0.001). Meanwhile, postprocedural TIMI flow grade 3 was less common in these patients (49.4% vs. 68.4%; odds ratio: 2.239; 95% confidence interval, 1.392-3.599; P = 0.001). High thrombus burden was more frequent in the patients with IRAE, with an odds ratio of 1.938 in the adjusted analysis. The corrected TIMI frame count was also significantly higher in the IRAE patients than in those without. Our STEMI patients with IRAE had impaired perfusion. Moreover, this group of patients more frequently had high thrombus burden. These patients might be at increased risk of unsuccessful revascularization probably due to distal embolization and no-reflow phenomenon, which could impact their short- and long-term outcomes. Because coronary ectasia is a known risk factor for acute coronary syndrome, it is beneficial that these patients be deemed high risk and kept under close monitoring.