In-hospital and long-term clinical outcomes of spontaneous coronary artery dissection (SCAD): a meta-analysis of conservative versus revascularization approaches

• Published in: The Egyptian heart journal Vol. 76; no. 1; pp. 153 - 18
• Main Authors: Pitliya, Anmol, Pitliya, Aakanksha, Vasudevan, Srivatsa Surya, Yadav, Kumari Priya, Shabbir, Muhammad Bilal, Zahoor, Shaghaf, Shabbir, Aisha, Ibrahim, Abdulgafar Dare, Jeswani, Bijay Mukesh, Jonnala, Ramya Reddy, Singla, Ramit
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 22-11-2024; Springer; Springer Nature B.V; SpringerOpen
• Subjects: Acute coronary syndromes; Age; Cardiology; Care and treatment; Case reports; Clinical outcomes; Cohort analysis; Coronary artery dissection; Coronary disease; Coronary heart disease; Coronary vessels; Dissected coronary artery; Dissection; Heart attacks; Hypotheses; Identification; Ischemia; Ischemic heart disease; Medical imaging; Medicine; Medicine & Public Health; Meta-analysis; Patient outcomes; Review; Software; Spontaneous coronary artery dissection; Strategic planning (Business); Surgery; Veins & arteries; United States; France; Ischemic heart disease; Coronary artery dissection; Spontaneous coronary artery dissection; Coronary disease; Dissected coronary artery
• ISSN: 2090-911X; 1110-2608; 2090-911X
• DOI: 10.1186/s43044-024-00585-0

Background
The ideal treatment strategy for spontaneous coronary artery dissection (SCAD) remains unclear, with patients potentially treated with either conservative medical care or a revascularization approach.
Methods
We performed a systematic review and meta-analysis adhering to PRISMA 2020 guidelines. Inclusion criteria involved studies with confirmed SCAD diagnosis, reporting initial management strategies, and original research with ≥ 10 participants. Random-effect models were applied for insignificant heterogeneity with significance at
p
 ≤ 0.05. Sensitivity analysis and funnel plots assessed potential publication bias.
Results
Our analysis found no significant differences in major adverse cardiac events (MACE) (OR = 0.61,
p
 = 0.49), unstable angina pectoris (UAP) (OR = 1.04,
p
 = 0.93), non-ST segment elevation myocardial infarction (NSTEMI) (OR = 1.16,
p
 = 0.82), recurrent myocardial infarction (MI) (OR = 0.78,
p
 = 0.56), stroke (OR = 0.35,
p
 = 0.07), heart failure (OR = 0.41,
p
 = 0.24), in-hospital mortality (OR = 0.35,
p
 = 0.09), post-discharge mortality (OR = 1.66,
p
 = 0.27), or ST segment elevation myocardial infarction (STEMI) (OR = 0.45,
p
 = 0.23) between conservative management and revascularization procedures. However, sensitivity analysis reveals significant decreases in odds of inferior wall STEMI (OR = 0.41 [95% CI 0.17–0.97],
p
 = 0.04) and heart failure (OR = 0.18 [95% CI 0.06–0.54],
p
 = 0.002) in conservative treatment compared to revascularization group.
Conclusion
Conservative therapy significantly decreased inferior wall STEMI and heart failure as compared to revascularization in SCAD. Although no significant differences in cardiovascular outcomes, sensitivity analysis highlights potential benefits of conservative management.