{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:05:39Z","timestamp":1791259539665,"version":"4.1.0"},"reference-count":33,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Coronary artery ectasia (CAE) presents challenges, specifically in the context of percutaneous coronary intervention (PCI), and has been associated with adverse events, particularly in the setting of acute myocardial infarction (AMI). The objective of the present study was to assess whether CAE is associated with increased occurrence of major adverse cardiovascular events (MACEs) in patients with AMI. Methods: A systematic review and meta-analysis of observational studies were conducted. We systematically searched MEDLINE via PubMed, Scopus, the Cochrane Library (CENTRAL), ClinicalTrials.gov, and reference lists to identify eligible studies. Baseline characteristics, comorbidities, angiographic data, and rates of MACEs and their individual components (all-cause or cardiovascular mortality, repeat AMI, repeat revascularization, stroke, and heart failure) have been extracted. The results were synthesized as odds ratios (ORs) using random-effects models. Results: Ten studies and 13,908 patients were included. CAE was found to be predictive of higher odds of MACEs [OR: 2.12, 95% CI: 1.34 to 3.36]. No difference was found regarding the odds of all-cause and cardiac death. The presence of ectasia was associated with higher odds of recurrent AMI, compared with controls [OR: 2.76, 95% CI:1.62 to 4.71]. The groups were comparable regarding the need for repeat revascularization, while the reports on stroke and heart failure were scarce. Conclusions: The results highlight the compounding effect of CAE on future MACE events in patients with AMI. Patients with AMI and CAE have higher odds of repeat AMI compared to patients without CAE, while mortality and repeat revascularization rates are similar. This might indicate the need for more aggressive treatment strategies in these patients.<\/jats:p>","DOI":"10.3390\/jcm15093482","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T16:54:07Z","timestamp":1777654447000},"page":"3482","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Major Adverse Cardiovascular Events in Patients with Acute Myocardial Infarction and Angiographic Evidence of Coronary Artery Ectasia: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1721-6468","authenticated-orcid":false,"given":"Nikolaos","family":"Otountzidis","sequence":"first","affiliation":[{"name":"First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0190-5392","authenticated-orcid":false,"given":"Nikolaos","family":"Stalikas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Center OLV Hospital, Moorsellbaan 1654, B-9300 Aalst, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0182-8259","authenticated-orcid":false,"given":"Amalia","family":"Baroutidou","sequence":"additional","affiliation":[{"name":"First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8328-5942","authenticated-orcid":false,"given":"Efstratios","family":"Karagiannidis","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8046-0602","authenticated-orcid":false,"given":"Matthaios","family":"Didagelos","sequence":"additional","affiliation":[{"name":"First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0019-0134","authenticated-orcid":false,"given":"Barbara","family":"Fyntanidou","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonios","family":"Ziakas","sequence":"additional","affiliation":[{"name":"First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7491-6319","authenticated-orcid":false,"given":"George","family":"Giannakoulas","sequence":"additional","affiliation":[{"name":"First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1161\/01.CIR.67.1.134","article-title":"Aneurysmal Coronary Artery Disease","volume":"67","author":"Swaye","year":"1983","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.ijcard.2022.04.005","article-title":"Mortality Outcomes and 30-Day Readmissions Associated with Coronary Artery Aneurysms; a National Database Study","volume":"356","author":"Mir","year":"2022","journal-title":"Int. J. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1097\/CRD.0b013e3181852659","article-title":"Coronary Artery Aneurysms: A Review of the Natural History, Pathophysiology, and Management","volume":"16","author":"Cohen","year":"2008","journal-title":"Cardiol. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/j.jcin.2018.02.041","article-title":"Management of Coronary Artery Aneurysms","volume":"11","author":"Kawsara","year":"2018","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"T64","DOI":"10.4244\/EIJV10STA11","article-title":"The Conundrum of Antithrombotic Drugs before, during and after Primary PCI","volume":"10","author":"Cortese","year":"2014","journal-title":"EuroIntervention"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s11239-021-02603-3","article-title":"Impact of Thrombus Burden on Long-Term Clinical Outcomes in Patients with Either Anterior or Non-Anterior ST-Segment Elevation Myocardial Infarction","volume":"54","author":"Scarparo","year":"2022","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.carrev.2017.12.003","article-title":"Coronary Aneurysms in the Acute Patient: Incidence, Characterization and Long-Term Management Results","volume":"19","author":"Terol","year":"2018","journal-title":"Cardiovasc. Revascularization Med. Incl. Mol. Interv."},{"key":"ref_8","first-page":"171","article-title":"One-Year Outcome of Patients with Coronary Artery Ectasia Undergoing Percutaneous Coronary Intervention: Clinical Implications and Question Marks","volume":"15","author":"Amirzadegan","year":"2020","journal-title":"J. Tehran Heart Cent."},{"key":"ref_9","first-page":"29","article-title":"High Prevalence of Coronary Artery Events and Non-Coronary Events in Patients with Coronary Artery Aneurysm in the Observational Group","volume":"10","author":"Warisawa","year":"2016","journal-title":"Int. J. Cardiol. Heart Vasc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"161","DOI":"10.3109\/14017431.2014.902495","article-title":"Patterns of Coronary Artery Ectasia and Short-Term Outcome in Acute Myocardial Infarction","volume":"48","author":"Boles","year":"2014","journal-title":"Scand. Cardiovasc. J. SCJ"},{"key":"ref_11","first-page":"748","article-title":"Risk Factors and Outcomes in Patients with Ectatic Infarct-Related Artery Who Underwent Primary Percutaneous Coronary Intervention after ST Elevated Myocardial Infarction","volume":"88","author":"Ipek","year":"2016","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.carrev.2021.11.042","article-title":"Characteristics and Outcomes of Patients with Coronary Artery Ectasia Presenting with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention","volume":"40","author":"Djohan","year":"2022","journal-title":"Cardiovasc. Revascularization Med. Incl. Mol. Interv."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1093\/eurheartj\/ehaa575","article-title":"2020 ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation","volume":"42","author":"Collet","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting with ST-Segment Elevation: The Task Force for the Management of Acute Myocardial Infarction in Patients Presenting with ST-Segment Elevation of the European Soci","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"101626","DOI":"10.1016\/j.cpcardiol.2023.101626","article-title":"Long-Term Outcomes of Acute Myocardial Infarction in Pre-Existing Coronary Artery Ectasia: A Systematic Review and Meta-Analysis","volume":"48","author":"Eid","year":"2023","journal-title":"Curr. Probl. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.jclinepi.2016.01.021","article-title":"PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Statement","volume":"75","author":"McGowan","year":"2016","journal-title":"J. Clin. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jclinepi.2020.01.008","article-title":"A Full Systematic Review Was Completed in 2 Weeks Using Automation Tools: A Case Study","volume":"121","author":"Clark","year":"2020","journal-title":"J. Clin. Epidemiol."},{"key":"ref_19","unstructured":"Wells, G.A., Shea, B., O\u2019Connell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2025, November 19). The Newcastle\u2013Ottawa Scale (NOS) for Assessing the Quality If Nonrandomized Studies in Meta-Analyses. Available online: Http:\/\/www.Ohri.ca\/Programs\/Clinical_epidemiology\/Oxford.Asp."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/j.hlc.2016.12.006","article-title":"Outcomes After Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Caused by Ectatic Infarct Related Arteries","volume":"26","author":"Shanmugam","year":"2017","journal-title":"Heart Lung Circ."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2350","DOI":"10.1161\/ATVBAHA.117.309683","article-title":"Coronary Artery Ectasia Predicts Future Cardiac Events in Patients With Acute Myocardial Infarction","volume":"37","author":"Doi","year":"2017","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_22","first-page":"340","article-title":"Clinical Outcome of Patients with ST-Elevation Myocardial Infarction and Angiographic Evidence of Coronary Artery Ectasia","volume":"99","author":"Baldi","year":"2022","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_23","first-page":"623","article-title":"Coronary Flow Improvement Following Unsuccessful Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction with Diffuse Ectatic Coronary Artery","volume":"6","author":"Fujii","year":"2017","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.amjcard.2021.06.037","article-title":"Prevalence and Long-Term Outcomes of Patients with Coronary Artery Ectasia Presenting with Acute Myocardial Infarction","volume":"156","author":"Wang","year":"2021","journal-title":"Am. J. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3006","DOI":"10.1016\/j.jacc.2017.04.030","article-title":"Patient Outcomes with STEMI Caused by Aneurysmal Coronary Artery Disease and Treated with Primary PCI","volume":"69","author":"Iannopollo","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Liu, R., Gao, X., Liang, S., and Zhao, H. (2022). Five-Years\u2019 Prognostic Analysis for Coronary Artery Ectasia Patients with Coronary Atherosclerosis: A Retrospective Cohort Study. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.950291"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Esposito, L., Di Maio, M., Silverio, A., Cancro, F.P., Bellino, M., Attisano, T., Tarantino, F.F., Esposito, G., Vecchione, C., and Galasso, G. (2021). Treatment and Outcome of Patients With Coronary Artery Ectasia: Current Evidence and Novel Opportunities for an Old Dilemma. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.805727"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.ijcard.2020.05.054","article-title":"Diffuse Coronary Artery Dilation Predicted Worse Long-Term Outcomes in Patients with Coronary Artery Ectasia","volume":"319","author":"Cai","year":"2020","journal-title":"Int. J. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"939","DOI":"10.12659\/AJCR.900474","article-title":"Recurrent Acute Myocardial Infarction in a Patient with Severe Coronary Artery Ectasia: Implication of Antithrombotic Therapy","volume":"17","author":"Tomioka","year":"2016","journal-title":"Am. J. Case Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1016\/S0735-1097(99)00375-7","article-title":"Exercise-Induced Myocardial Ischemia in Isolated Coronary Artery Ectasias and Aneurysms (\u201cdilated Coronopathy\u201d)","volume":"34","author":"Stierle","year":"1999","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"230421189013","DOI":"10.2174\/1573403X16999201210195702","article-title":"Myocardial Infarction with and without ST-segment Elevation: A Contemporary Reappraisal of Similarities and Differences","volume":"17","author":"Mitsis","year":"2021","journal-title":"Curr. Cardiol. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1007\/s40256-025-00739-8","article-title":"One-Year Prognostic Differences and Management Strategies between ST-Elevation and Non-ST-Elevation Myocardial Infarction: Insights from the PRAISE Registry","volume":"25","author":"Spadafora","year":"2025","journal-title":"Am. J. Cardiovasc. Drugs"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2086","DOI":"10.1016\/j.jcin.2016.08.011","article-title":"Impact of Operator Experience and Volume on Outcomes After Left Main Coronary Artery Percutaneous Coronary Intervention","volume":"9","author":"Xu","year":"2016","journal-title":"JACC Cardiovasc. Interv."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3482\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T04:16:50Z","timestamp":1778127410000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3482"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,1]]},"references-count":33,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15093482"],"URL":"https:\/\/doi.org\/10.3390\/jcm15093482","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,1]]}}}