•The prevalence and long-term prognosis of coronary artery aneurysms is unclear.•CAAR is a coronary artery aneurysm registry conducted in 32 hospitals in 9 countries.•436,467 consecutive angiograms were reviewed, and 1565 patients included.•Aneurysmal coronary artery disease is not uncommon in cath lab current practice.•It is associated with high cardiovascular risk burden and high rate of events (>30%).