Multicenter Trial of Antithrombotic Strategies in Acute Coronary Syndrome With Coronary Artery Ectasia

Inclusion Criteria: * Adults aged 18 to 80 years, of either sex, hospitalized with acute coronary syndrome (ACS) with or without ST-segment elevation. * Recent ACS within 7 days prior to enrollment, defined by all of the following: * Clinical presentation consistent with acute coronary syndrome. * Elevated high-sensitivity cardiac troponin above the 99th percentile. * Presence or absence of persistent ST-segment elevation. * Coronary artery ectasia in the culprit coronary artery, defined by all of the following: * The presence of ectasia will be determined by agreement of two expert interventional cardiologists, and will be confirmed by quantitative coronary angiography (QCA). * Identification of a culprit artery consistent with the electrocardiographic territory involved (in cases with ST-segment elevation) or with angiographic features suggestive of an atherothrombotic event, such as the presence of thrombus or reduced coronary flow. * Hospital admission lasting more than 24 hours. * Management with either percutaneous coronary intervention or medical therapy, as determined by the treating medical team. Intracoronary interventions such as stent implantation, balloon angioplasty, or thrombus aspiration are permitted. * Ability and willingness to provide written informed consent and to participate in the study. Exclusion Criteria: * Pregnant women. * Current indication for temporary or long-term anticoagulation therapy at the time of enrollment. * Severe chronic kidney dis…