Research Article

Fluoroquinolone Exposure and Coronary Artery Ectasia: A Retrospective Angiography-Based Case-Control Study

Volume: 5 Number: 1 October 26, 2026

Fluoroquinolone Exposure and Coronary Artery Ectasia: A Retrospective Angiography-Based Case-Control Study

Abstract

Objective: Fluoroquinolones have been linked to collagen-related adverse events and aortic aneurysm or dissection, but their relationship with coronary artery ectasia (CAE) is unknown. We evaluated whether documented systemic fluoroquinolone exposure was associated with angiographically defined CAE and with CAE anatomic phenotype. Material and Methods: In this retrospective case-control study, 530 adults undergoing coronary angiography between January 2023 and May 2024 were included: 267 with CAE and 263 angiographic controls. The exposure was documented systemic fluoroquinolone use before angiography, ascertained from institutional prescribing and medication records. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) with sequential adjustment for demographics, cardiovascular risk factors, angiographic indication, and other antibiotic and non-steroidal anti-inflammatory drug exposure. Cumulative dose, active-comparator, overlap-weighted, and case-only analyses were supportive. Results: Fluoroquinolone exposure was present in 152 of 267 cases (56.9%) and 71 of 263 controls (27.0%). The unadjusted OR was 3.57, 95% CI [2.48, 5.15]; the association persisted after adjustment for measured clinical and medication covariates, OR = 3.83, 95% CI [2.61, 5.62], p < .001. Among 223 exposed participants, an exploratory dose trend was detected (adjusted OR per category = 2.55, 95% CI [1.66, 3.91], p < .001). Findings were consistent in active-comparator and overlap-weighted analyses. Among cases, no statistically significant association with multivessel or diffuse Markis type I/II CAE was detected. Conclusion: Documented fluoroquinolone exposure was associated with CAE after adjustment for measured covariates; no statistically significant association with angiographic extent was detected among CAE cases. These findings are hypothesis-generating and require confirmation in multicenter, pharmacy-linked studies.

Keywords

Coronary aneurysm, Coronary angiography, Case-control study, Fluoroquinolones, Matrix metalloproteinases, Vascular remodeling

Supporting Institution

None.

Ethical Statement

Ethical approval for this study was obtained from the Adana City Training and Research Hospital Ethics Committee (Approval No: 2695, Date: 06.07.2023). Owing to the retrospective design, the requirement for written informed consent was waived by the ethics committee. The study was conducted in accordance with the 1964 Declaration of Helsinki and its subsequent amendments and the relevant regulations of the Republic of Türkiye Ministry of Health.

Thanks

None.

References

  1. Abou Sherif, S., Ozden Tok, O., Taşköylü, Ö., Goktekin, O., & Kilic, I. D. (2017). Coronary artery aneurysms: A review of the epidemiology, pathophysiology, diagnosis, and treatment. Frontiers in Cardiovascular Medicine, 4, Article 24. https://doi.org/10.3389/fcvm.2017.00024
  2. Argan, O., & Bozyel, S. (2025). C-reactive protein, uric acid, and coronary artery ectasia in patients with coronary artery disease. Medical Science Monitor, 31, Article e947158. https://doi.org/10.12659/MSM.947158
  3. Aspinall, S. L., Sylvain, N. P., Zhao, X., Zhang, R., Dong, D., Echevarria, K., Glassman, P. A., Goetz, M. B., Miller, D. R., & Cunningham, F. E. (2020). Serious cardiovascular adverse events with fluoroquinolones versus other antibiotics: A self-controlled case series analysis. Pharmacology Research & Perspectives, 8(6), Article e00664. https://doi.org/10.1002/prp2.664
  4. Chen, Y.-Y., Yang, S.-F., Yeh, H.-W., Yeh, Y.-T., Huang, J.-Y., Tsao, S.-L., & Yeh, C.-B. (2022). Association between aortic aneurysm and aortic dissection with fluoroquinolones use in patients with urinary tract infections: A population-based cohort study. Journal of the American Heart Association, 11(6), Article e023267. https://doi.org/10.1161/JAHA.121.023267
  5. Corps, A. N., Harrall, R. L., Curry, V. A., Fenwick, S. A., Hazleman, B. L., & Riley, G. P. (2002). Ciprofloxacin enhances the stimulation of matrix metalloproteinase 3 expression by interleukin-1beta in human tendon-derived cells. A potential mechanism of fluoroquinolone-induced tendinopathy. Arthritis & Rheumatism, 46(11), 3034-3040. https://doi.org/10.1002/art.10617
  6. Dahi, S., Karliner, J. S., Sarkar, R., & Lovett, D. H. (2011). Transgenic expression of matrix metalloproteinase-2 induces coronary artery ectasia. International Journal of Experimental Pathology, 92(1), 50-56. https://doi.org/10.1111/j.1365-2613.2010.00744.x
  7. Daneman, N., Lu, H., & Redelmeier, D. A. (2015). Fluoroquinolones and collagen associated severe adverse events: A longitudinal cohort study. BMJ Open, 5(11), Article e010077. https://doi.org/10.1136/bmjopen-2015-010077
  8. Dogan, A., Tuzun, N., Turker, Y., Akcay, S., Kaya, S., & Ozaydin, M. (2008). Matrix metalloproteinases and inflammatory markers in coronary artery ectasia: Their relationship to severity of coronary artery ectasia. Coronary Artery Disease, 19(8), 559-563. https://doi.org/10.1097/MCA.0b013e3283109079
  9. European Medicines Agency. (2018, November 16). Disabling and potentially permanent side effects lead to suspension or restrictions of quinolone and fluoroquinolone antibiotics [Press release]. https://www.ema.europa.eu/en/news/disabling-potentially-permanent-side-effects-lead-suspension-or-restrictions-quinolone-fluoroquinolone-antibiotics
  10. Finkelstein, A., Michowitz, Y., Abashidze, A., Miller, H., Keren, G., & George, J. (2005). Temporal association between circulating proteolytic, inflammatory and neurohormonal markers in patients with coronary ectasia. Atherosclerosis, 179(2), 353-359. https://doi.org/10.1016/j.atherosclerosis.2004.10.020
APA
Bedir, Ö., Coşkun, M., Gençaslan, M., Doğan, R., Kümet, Ö., & Evlıce, M. (2026). Fluoroquinolone Exposure and Coronary Artery Ectasia: A Retrospective Angiography-Based Case-Control Study. Farabi Medical Journal, 5(1), 1-20. https://doi.org/10.59518/farabimedj.2017705
AMA
1.Bedir Ö, Coşkun M, Gençaslan M, Doğan R, Kümet Ö, Evlıce M. Fluoroquinolone Exposure and Coronary Artery Ectasia: A Retrospective Angiography-Based Case-Control Study. Farabi Medical Journal. 2026;5(1):1-20. doi:10.59518/farabimedj.2017705
Chicago
Bedir, Ömer, Mükremin Coşkun, Murat Gençaslan, Remziye Doğan, Ömer Kümet, and Mert Evlıce. 2026. “Fluoroquinolone Exposure and Coronary Artery Ectasia: A Retrospective Angiography-Based Case-Control Study”. Farabi Medical Journal 5 (1): 1-20. https://doi.org/10.59518/farabimedj.2017705.
EndNote
Bedir Ö, Coşkun M, Gençaslan M, Doğan R, Kümet Ö, Evlıce M (October 1, 2026) Fluoroquinolone Exposure and Coronary Artery Ectasia: A Retrospective Angiography-Based Case-Control Study. Farabi Medical Journal 5 1 1–20.
IEEE
[1]Ö. Bedir, M. Coşkun, M. Gençaslan, R. Doğan, Ö. Kümet, and M. Evlıce, “Fluoroquinolone Exposure and Coronary Artery Ectasia: A Retrospective Angiography-Based Case-Control Study”, Farabi Medical Journal, vol. 5, no. 1, pp. 1–20, Oct. 2026, doi: 10.59518/farabimedj.2017705.
ISNAD
Bedir, Ömer - Coşkun, Mükremin - Gençaslan, Murat - Doğan, Remziye - Kümet, Ömer - Evlıce, Mert. “Fluoroquinolone Exposure and Coronary Artery Ectasia: A Retrospective Angiography-Based Case-Control Study”. Farabi Medical Journal 5/1 (October 1, 2026): 1-20. https://doi.org/10.59518/farabimedj.2017705.
JAMA
1.Bedir Ö, Coşkun M, Gençaslan M, Doğan R, Kümet Ö, Evlıce M. Fluoroquinolone Exposure and Coronary Artery Ectasia: A Retrospective Angiography-Based Case-Control Study. Farabi Medical Journal. 2026;5:1–20.
MLA
Bedir, Ömer, et al. “Fluoroquinolone Exposure and Coronary Artery Ectasia: A Retrospective Angiography-Based Case-Control Study”. Farabi Medical Journal, vol. 5, no. 1, Oct. 2026, pp. 1-20, doi:10.59518/farabimedj.2017705.
Vancouver
1.Ömer Bedir, Mükremin Coşkun, Murat Gençaslan, Remziye Doğan, Ömer Kümet, Mert Evlıce. Fluoroquinolone Exposure and Coronary Artery Ectasia: A Retrospective Angiography-Based Case-Control Study. Farabi Medical Journal. 2026 Oct. 1;5(1):1-20. doi:10.59518/farabimedj.2017705