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

Abstract

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.