BACKGROUND: Limited data are available to guide the management of coronary artery aneurysms (CAAs). OBJECTIVES: The authors sought to define the clinical characteristics, identify variables that predict outcomes, and provide long-term data on CAAs. METHODS: We describe outcomes from 1,729 consecutive patients with CAAs included in an ambispective international registry (CAAR [Coronary Artery Aneurysm Registry]; NCT02563626) involving 33 hospitals across 9 countries in America and Europe. RESULTS: Patients were predominantly male (78.6%; 1,359/1,729) with a mean age of 66 years. Classic cardiovascular risk factors were common, as well as coronary artery disease (85.8%; 1,484/1,729), peripheral vascular disease (10.9%; 188/1,729), and chronic kidney disease (8.0%; 138/1,729). The median number of aneurysms per patient was 1.0 (Q1-Q3: 1.0-1.0), with the most affected territory being the left anterior descending artery (49.6%; 857/1,729). The majority underwent any revascularization procedure (68.5%; 1,184/1,729), mainly percutaneous coronary intervention (50.7%; 877/1,729), and were discharged on dual antiplatelet therapy (65.6%; 1,134/1,729). After a median follow-up of 44.8 months (Q1-Q3: 14.9-88.1), 379 died (21.9%), and 641 (37.1%) developed a major adverse cardiovascular event (MACE) (all-cause death, heart failure, unstable angina, and reinfarction). In a multivariable analysis, age (HR: 1.03; 95% CI: 1.02-1.04; P < 0.001), diabetes mellitus (HR: 1.47; 95% CI: 1.23-1.75; P < 0.001), renal insufficiency (HR: 1.53; 95% CI: 1.19-1.96; P = 0.010), peripheral vessel disease (HR: 1.43; 95% CI: 1.13-1.82; P = 0.003), reduced left ventricular ejection fraction (HR: 0.98; 95% CI: 0.98-0.99; P < 0.001), acute indication for the index coronary angiography (HR: 1.30; 95% CI: 1.08-1.55; P = 0.005), and the number of coronary vessels presenting severe stenosis (HR: 1.11; 95% CI: 1.02-1.20; P = 0.015) were independent predictors of MACEs. Remarkably, only 37 patients presented with local aneurysm complications during follow-up. CONCLUSIONS: The long-term prognosis of CAAs is not favorable, with MACEs associated with the underlying risk factor profile for atherosclerotic heart disease.

Cardiology Città della Salute e della Scienza Molinnette 1 Torino Italy

Cardiology Department Hospital Álvaro Cunqueiro University Hospital of Vigo Vigo Pontevedra Spain; Cardiovascular Research Group Galicia Sur Health Research Institute SERGAS UVIGO Vigo Spain

Cardiology Department Hospital Central de Asturias Oviedo Spain

Cardiology Department Hospital Fundación Jiménez Diaz Madrid Spain

Cardiology Department Hospital Universitario de La Princesa IIS IP CIBER CV Universidad Autónoma de Madrid Madrid Spain

Cardiology Department Hospital Universitario Marqués de Valdecilla IDIVAL Santander Spain

Cardiology Hospital Universitario de Torrejón Madrid Spain

Cardiology Instituto Dominicano de Cardiología Santo Domingo Dominican Republic

CIBERCV Interventional Cardiology Hospital Clínico Universitario de Valladolid Valladolid Spain

Cuban Society of Basic Biomedical Sciences Havana Cuba; Interventional Cardiology Hospital de Bellvitge Barcelona Spain

Department of Cardiology Mayo Clinic Rochester Minnesota USA

Department of Clinical Internal Anesthesiology and Cardiovascular Sciences Sapienza University of Rome Rome Italy

Department of Internal Medicine and Cardiology University Hospital Brno Brno Czech Republic; Medical Faculty of Masaryk University Brno Czech Republic

Division of Cardiovascular and Thoracic Anesthesiology Department of Anesthesiology and Perioperative Medicine Mayo Clinic Rochester Minnesota USA

Interventional Cardiology H General Universitario de Albacete Albacete Spain

Interventional Cardiology H Lozano Blesa Zaragoza Spain

Interventional Cardiology H Universitario de Canarias San Cristobal de la Laguna Spain

Interventional Cardiology Henry Ford Hospital Detroit Michigan USA

Interventional Cardiology Hospital Arnau de Vilanova Lérida Spain

Interventional Cardiology Hospital Clínico San Carlos IdISSC Madrid Spain; Faculty of Medicine Universidad Complutense de Madrid Madrid Spain

Interventional Cardiology Hospital Clínico San Carlos IdISSC Madrid Spain; Faculty of Medicine Universidad Complutense de Madrid Madrid Spain; Cardiology Hospital Universitario de Torrejón Madrid Spain; Faculty of Biomedical and Health Sciences Universidad Europea de Madrid Madrid Spain

Interventional Cardiology Hospital Clínico San Carlos IdISSC Madrid Spain; Faculty of Medicine Universidad Complutense de Madrid Madrid Spain; Centro Nacional de Investigaciones Cardiovasculares Madrid Spain

Interventional Cardiology Hospital de Bellvitge Barcelona Spain

Interventional Cardiology Hospital de Cabueñes Gijón Spain

Interventional Cardiology Hospital Juan Ramón Jiménez Huelva Spain

Interventional Cardiology Hospital La Luz Madrid Spain

Interventional Cardiology Ospedale Maggiore Lodi Italy

Interventional Cardiology Unit San Luca Hospital Milan Italy

Interventional Cardiology Unit Sant'Andrea Hospital Vercelli Italy

Interventional Cardiology Utrecht Medisch Centrum Utrecht the Netherlands

Interventional Unit San Luigi Gonzaga University Hospital Orbassano Turin Italy; Rivoli Infermi Hospital Rivoli Turin Italy

Kerckhoff Heart and Thorax Center Department of Cardiology Bad Nauheim Germany; DZHK Partner Site Rhein Main Frankfurt am Main Germany

U O Cardiologia Ospedaliera IRCCS Ospedale Galeazzi Sant'Ambrogio Milan Italy

Unidad Académica de Cardiología Hospital de Clínicas Dr Manuel Quintela Montevideo Uruguay

UO di Cardiologia Interventistica ed Emodinamica Azienda Ospedaliera Universitaria Policlinico P Giaccone Palermo Italy

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