Rationale and design of a multicenter, international and collaborative coronary artery aneurysm registry (CAAR)

Coronary artery aneurysm has been classically defined as a coronary dilation that exceeds the diameter of normal adjacent segments or the diameter of the patient’s largest coronary vessel by 1.5×. Termed by Bourgon,1 it is an uncommon disease that has been diagnosed with increasing occurrence since the advent of coronary angiography.2,3 The incidence has been reported to vary from 1.5% to 5%, with suggested male dominance and a predilection for the right coronary artery.2,3 Although several causes have been shown, atherosclerosis accounts for ≥50% of coronary aneurysms in adults. Reported complications include thrombosis and distal embolization, vasospasm, and rupture, producing ischemia, heart failure, or arrhythmias. The natural history and long-term outcomes remain unclear, as definitive data are lacking. In addition, controversies persist regarding the use of medical treatment (antithrombotic therapy) or interventional/surgical procedures.1–

Coronary artery aneurysms, insights from the international coronary artery aneurysm registry (CAAR)

Background: Coronary Aneurysms are a focal dilatation of an artery segment >1.5-fold the normal size of adjacent segments. Although some series have suggested a prevalence of 0.3–12%, data are lacking. In addition, they are not mentioned in practice guidelines. Our aim was investigate its prevalence, management and long-term outcomes. Methods and results: The coronary artery aneurysm registry (CAAR) involved 32 hospitals across 9 countries in America and Europe. We reviewed 436,467 consecutive angiograms performed over the period 2004–2016. Finally, 1565 patients were recruited. Aneurysm global prevalence was 0.35%. Most patients were male (78.5%) with a mean age of 65 years and frequent cardiovascular risk factors. The main indication for angiogram was an acute coronary syndrome, 966 cases. The number of aneurisms was ≤2 per patient in 95.8% of the cases, mostly saccular, most frequently found in the left anterior descending and with numbers proportional with coronary stenosis. Aortopathies were related with more aneurysms too. Most patients received any revascularization procedure (69%), commonly percutaneous (53%). After a median follow-up of 37.2 months, 485 suffered a combined event (MACE) and 240 died. Without major differences comparing CABG vs PCI, MACE and death were more frequent in patients who received bare metal stents. Conclusions: Coronary artery aneurysms are not uncommon. Usually, they are associated with coronary stenosis and high cardiovascular risk. Antiplatelet therapy seems reasonable and a percutaneous approach is safe and effective

Stress neuropeptide levels in adults with chest pain due to coronary artery disease: potential implications for clinical assessment

: Substance P (SP) and neuropeptide Y (NPY) are neuropeptides involved in nociception. The study of biochemical markers of pain in communicating critically ill coronary patients may provide insight for pain assessment and management in critical care. Purpose of the study was to to explore potential associations between plasma neuropeptide levels and reported pain intensity in coronary critical care adults, in order to test the reliability of SP measurements for objective pain assessment in critical care