J Korean Med Sci.  2023 Nov;38(45):e379. 10.3346/jkms.2023.38.e379.

The Prognostic Impact of Coronary Artery Disease and Aortic Aneurysm: Insights From CT Protocol for Simultaneous Evaluation of Coronary Artery and Aorta

• Kim H
• Kim J
• Choe YH
• Kim SM

• KMID: 2547982
• DOI: http://doi.org/10.3346/jkms.2023.38.e379

Abstract

Background
There is a strong correlation between risk factors for coronary artery disease (CAD) and aortic aneurysm (AA). We aimed to investigate the prevalence and prognostic impact of CAD and AA in patients who underwent coronary aorta computed tomography (CACT) protocol, which allowed simultaneous evaluation of coronary artery and aorta.
Methods
Between 2010 and 2021, 1,553 patients who underwent CACT were enrolled from a tertiary center. The presence and location of AA and the presence of CAD were identified from CT. The primary outcome was a composite of cardiovascular death, acute coronary syndrome requiring urgent revascularization, and stroke at 3 years after the index CT scan.
Results
Out of 1,553 enrolled patients, 179 (11.5%) had AA. The prevalence of CAD was significantly higher in patients with AA than those without (47.5% vs. 18.3%, P < 0.001). Among patients with AA, the prevalence of comorbid CAD was higher in those with abdominal AA than thoracic AA (57.3% vs. 37.8%, P = 0.014), respectively. In multivariable analysis, the presence of CAD was an independent predictor of primary outcome at 3 years (hazard ratio [HR], 2.58; 95% CI, 1.47–4.51; P = 0.001), while AA was not (HR, 1.00; 95% CI, 0.48–2.07; P = 0.993).
Conclusion
In this cohort of patients undergoing simultaneous evaluation of coronary artery and aorta using CACT protocol, patients with AA had an increased risk of comorbid CAD compared to those without AA. CAD was independently associated with adverse clinical outcomes at 3 years.

Keyword

Aortic Aneurysm; Coronary Artery Disease; Clinical Outcomes; Multidetector Computed Tomography; Computed Tomography Angiography

Figure

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  Fig. 1 Flow chart of patient enrollment.aOrgans other than left ventricle or small arteries including renal artery, hepatic artery, splenic artery etc. bGenetic vascular disease including Marfan syndrome, Loeys-Dietz syndrome, Ehler-Dalnos syndrome, familial arterial dissection, and aneurysms, congenital heart disease including coarctation of aorta, bicuspid aortic valve and others, and aneurysm caused by other than atherosclerosis including mycotic aneurysm, aneurysm with acute aortic syndromes (aortic dissection, acute intramural hematoma, penetrating atherosclerotic ulcer), pseudoaneurysm, ruptured aneurysm, saccular aneurysm. cTakayasu’s arteritis, Behcet’s disease, ankylosing spondylitis, giant cell aortitis, fibrosclerosing peri-aortitis, IgG4-related aortitis, Kawasaki disease, polyarteritis nodosa, polymyalgia rheumatica, sarcoidosis. dMitral regurgitation, aortic regurgitation, aortic stenosis, mitral stenosis. eHeart transplantation status, fibromuscular dysplasia, thromboangiitis obliterans, hereditary hemorrhagic telangiectasia.CT = computed tomography.

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  Fig. 2 Incidence of MACCE categorized based on the presence of aortic aneurysm.MACCE = major adverse cardiovascular and cerebrovascular event, CT = computed tomography, AA = aortic aneurysm.

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  Fig. 3 Incidence of MACCE categorized based on the presence of aortic aneurysm and coronary artery disease.MACCE = major adverse cardiovascular and cerebrovascular event, AA = aortic aneurysm, CT = computed tomography, CAD = coronary artery disease.

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