Coronary artery ectasia (CAE), is found in only 1% of acute myocardial infarction (AMI), but is a clinical challenge for percutaneous coronary intervention (PCI) of the culprit artery. Purpose We aim to assess the impact of CAE as culprit artery on management strategy.

From 2010 to 2019, we analyzed the characteristics, and management of 70 consecutive patients admitted for an AMI with CAE at coronary angiography. Patients with ectatic infarcted-related artery (ERIA) were compared with patients without ectasia on infarcted-related (No ERIA).

Most (67%) had ERIA. ERIA patients had more frequently diabetes (32 vs. 4%, P=0.01). The rate of other CV risk factors, and chronic medications, including antiplatelet agents and anticoagulants were similar for the 2 groups. Moreover, no difference was observed between the 2 groups for clinical parameters and biological data. Whatever the group, the ectatic artery is mainly located on the right coronary artery (RCA) (73%), of which most were ERIA (77%). ERIA group had less frequently anterior wall location STEMI (18 vs. 65%, P<0.001). The rate of diffuse coronary artery disease (91 vs. 92%) and maximum CAE diameter (6.36 (6.00–7.00) mm vs. 6.14 (5.53–7.64) mm, P=0.571) were similar for the 2 groups. SYNTAX was lower in ERIA patients (9.5 (2.0–18.0) vs. 13.5 (7.0–23.0), P=0.031). A complete reperfusion was more frequently achieved in no ERIA group (70vs47%, P=0.073) (Table 1).

CAE management is strongly dependent on the presence of CAE on IRA. Although rare, the optimal treatment strategy of patients with AMI and CAE remains to be elucidated. The place of intravascular ultrasound imaging needs to be investigated.