Background. This study aims to compare clinical outcomes of SCAD patients initially managed with medical therapy (conservative approach) versus intervention strategy. Materials and methods. We identified relevant studies by performing a systematic search in the PubMed, Google Scholar, Web of Science databases available from 1994 until 2021. The search was conducted using PICO tool (Patient, Intervention, Comparison, Outcome). Results and Discussion. 25 studies involving 2577 patients with SCAD were included. Mean age of patients was 49,2 years, 1985 (77,0 %) were female. The primary conservative strategy performed in 1593 (61,8 %) cases. Mean follow-up duration was 28,5 months. The conservative therapy showed benefit when assessing the overall mortality (OR 0,48; CI 0,27–0,86, p = 0,01) and revascularization frequency (OR 0,43; 95 % CI 0,22–0,81, p = 0.01). Statistically significant differences in myocardial infarction (OR 1,05; 95 % CI 0,66–1,66, p = 0,85) or recurrent SCAD (OR 1,1; 95 % CI 0,7–1,72, p = 0,69) were not revealed. Conclusion. The primary conservative strategy of SCAD therapy is associated with lower overall mortality and further revascularization, but not MI and recurrent SCAD. Further research is needed to clarify the best therapeutic approach in patients with SCAD.