Unravelling the link between inflammatory biomarkers and coronary artery ectasia severity: a systematic review and meta-analysis

Coronary artery ectasia (CAE), with increasing detection, and the role of inflammation remains controversial. This meta-analysis explored correlations between multiple inflammatory markers and the occurrence and severity of CAE. PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to July 2025 for relevant studies. Literature screening, data extraction, and quality assessment were performed. Meta-analysis was conducted using Review Manager 5.3, with fixed-or random-effect models based on heterogeneity; mean difference (MD), odds ratio (OR), bias risk, and sensitivity analyses were computed. Fifty-three studies involving 9,168 subjects were included. Compared with the control group, patients with CAE had higher levels of high-sensitivity C-reactive protein (hs-CRP), Interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). The ratio of white blood cells (WBC) to neutrophils in CAE patients was higher than that in coronary artery disease (CAD) and non-coronary artery (NCA) populations. Lymphocytes showed a gradient distribution of "NCA > CAE > CAD". The level of monocytes in CAE patients was higher than that in CAD patients, but similar to that in NCA patients. There was no significant correlation between the neutrophil-to-lymphocyte ratio (NLR) levels of CAE patients and those of CAD patients. The levels of hs-CRP and lymphocytes in CAE patients were positively correlated with the severity of CAE. Multivariate analysis showed that hs-CRP (OR=1.78) and WBC (OR=1.00) were the factors related to CAE. hs-CRP, IL-6, TNF-α, and various inflammatory cells are related to the occurrence of CAE. hs-CRP and lymphocytes can indicate the severity of CAE.