Adult isolated coronary artery ectasia: clinical features and long-term outcomes.

Background: Adult isolated coronary artery ectasia (ICAE) is a rare disease characterized by dilation of coronary arteries in the absence of significant stenosis. Its long-term prognosis and optimal management remain unclear. This study aimed to investigate the clinical and long-term outcomes of adult ICAE compared to controls with normal coronary arteries. Methods: This retrospective analysis utilized prospectively maintained coronary angiography databases at Guangdong Provincial People's Hospital (2012-2022). ICAE was defined as ≥1.5 times dilation with <20% stenosis. Adult patients meeting these criteria, after excluding cases with significant stenosis or secondary causes, were matched 1:1 by age and sex to controls with normal coronary arteries. Clinical, laboratory, ECG, echocardiographic, and angiographic data were collected. The primary outcome was all-cause mortality, and the secondary outcome was major adverse cardiovascular events (MACE). Results: The study included 171 adult ICAE patients and 171 matched controls. Compared to controls, ICAE patients exhibited a higher prevalence of hypertension, elevated cardiac biomarkers, and more frequent ECG abnormalities. Angiography showed a predilection for the LAD (70.8%) and frequent multivessel involvement; slow flow was noted in 26.9%. After a median 6.2-year follow-up, ICAE patients had a significantly increased risk of MACE (HR 2.17, 95% CI 1.23-3.82, Conclusions: Adult ICAE exhibits distinct clinical and angiographic features, consistent with a chronic ischemia-like phenotype and possible association with elevated MACE risk.