PREDIKTORI KORONARNE EKTAZIJE U BOLESNIKA KOJI SU PODVRGNUTI KORONARNOJ ANGIOGRAFIJI

Background: Coronary artery ectasia (CAE) is defined as localized or diffuse dilatation ≥1,5 times the normal vascular lumen. Coronary artery ectasia (dilated coronopathy) is a relatively rare abnormality (prevalence <2% in the general population) of the coronary arterial tree that is considered to be congenital (in 20%–30% of the cases) or acquired. Acquired coronary ectasias have been attributed most commonly to atherosclerosis (80%) and less commonly to inflammatory and connective tissue diseases. Pathologic studies reveal ectatic arterial enlargement, degeneration of the elastic lamina, medial atherosclerotic plaque formation or calcification, and thinning of the arterial wall. The cause of ectasia is still a subject of discussion. Newer subgroups of ectasia are arising with the use of multiple interventional devices to dilate coronary artery stenosis. By design, these destroy the media of the coronary artery, and it is not clear whether these “iatrogenic” ectatic arteries are subject to the same complications as “idiopathic” coronary artery ectasia. Ectasia classified into four subgroups whose frequency decreases going from type 1 to type 4. The first subgroup includes diffuse ectasia involving two or more vessels, the second subgroup comprises diffuse ectasia involving one vessel and localized ectasia involving another. Third subgroup includes diffuse ectasia involving one vessel only and the fourth subgroup includes localized or segmental ectasia only. Inflammation and atherosclerosis are important parameters for the formation of isolated coronary artery ectasia. In recent times the literature mention that the association between Helicobacer pylori and Chlamydia pneumoniae with the development of ectasia. The gold standard for diagnosis of ectasia is a coronary angiography. It as a diagnostic as well as therapeutic method provides significant information on the size, number of ectasia, their location and type. Objective: The main objective of this study was to determine differences in predictors of coronary artery ectasia in patients with coronary artery ectasia who underwent coronary angiography compared to two control groups: patients with normal artery and those with artery stenosis. Patients and Methods: The study included 126 medical histories of patients who, during 2013 and 2014 underwent coronary angiography in the University Hospital of Split, 5 of them being excluded because of incomplete information. Subjects were divided into three groups: the first group consists of 60 patients with coronary artery ectasia and two control groups in which randomly selected 30 patients who underwent coronary angiography and had normal artery, and 31 patients with artery stenosis. Each patient from medical histories processed personal information, personal history, predictors of coronary artery ectasia: biological risk factors that can not be influenced (age, gender, heritage); biological risk factors that can influenced (BMI, RR, blood glucose, smoking, cholestrol, HDL, LDL, triglycerides, uric acid, alcohol), markers of myocardial necrosis (troponin, CPK, CK-MB, LDH); markers of thrombosis (D-dimers) and inflammatory markers (CRP). Results: The results observed predictors of coronary artery ectasia between the observed groups in patients with ectatic, normal and stenotic artery indicate that there is a statistically significant difference in observed parameters. All known risk factors, except alcohol, were confirmed as a possible cause of ectasia. Lipidograms values are consistent with the expectations of the patients with all types of vessels other than the value of LDL in patients with normal artery, which is the highest value of said group. In subtypes of ectasia stand out the type 3 in all these parameters. The values of troponin, CPK, CK-MB, LDH and CRP were higher in patients with ectatic artery and artery stenosis compared to the group of patients with normal blood vessels, which is consistent with the assumption that these parameters are involved in the development of ectasia. Conclusion: There are significant differences in predictors of coronary artery ectasia between patients with different types of blood vessels and in the value of troponin in patients with normal artery, and patients with ectatic artery, who underwent coronary angiography, then the values of total cholesterol, uric acid, torponin, CPK and LDH in patients with normal artery, and patients with artery stenosis, and finally in CPK levels between patients with ectatic artery, and patients with artery stenosis. There was no statistically significant difference between the value of predictors of coronary artery ectasia and subtypes of ectasia. There are significant differences between CRP levels and all subtypes of ectatic blood vessels.