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Spontaneous Coronary Artery Dissection Managed With a Conservative or Revascularization Approach: A Meta-Analysis Publisher Pubmed



Jamil A1 ; Tajrishi FZ2 ; Kahe F3 ; Najafi H3 ; Montazerin SM3 ; Shojaei F3 ; Chitsazan M3 ; Chitsazan M3 ; Liu Y5 ; Chi G3
Authors
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Authors Affiliations
  1. 1. OSF Saint Francis Medical Center, Peoria, IL, United States
  2. 2. Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
  4. 4. Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
  5. 5. Baim Institute for Clinical Research, Boston, MA, United States

Source: Journal of Cardiovascular Medicine Published:2020


Abstract

BackgroundThe optimal treatment approach for spontaneous coronary artery dissection (SCAD) remains unclear.ObjectivesThe study aims to compare in-hospital and long-term clinical outcomes of SCAD patients initially managed with medical therapy (conservative approach) versus percutaneous coronary intervention or coronary artery bypass grafting (revascularization approach) based on published data.MethodsWe identified relevant studies by performing a systematic search in the Ovid MEDLINE and Embase databases. Studies with N at least 10 that report in-hospital outcomes [death, myocardial infarction (MI) and revascularization] or long-term outcomes (death, MI, revascularization, SCAD recurrence, and heart failure) were included. Risk difference between conservative and revascularization approach was estimated with the inverse variance-weighted method in a fixed-effect or random-effect model.ResultsA total of 22 nonrandomized, observational studies were analyzed (N=1435). Compared with the initial revascularization approach, the conservative approach was associated with a comparable risk of in-hospital outcomes [risk difference: death, -0.61% (95% confidence interval, -2.13-0.91%), P=0.43; MI, -0.99% (-4.65-2.67%), P=0.60; revascularization, -3.02% (-8.79-2.75%), P=0.31] and long-term outcomes [death, -0.06% (-2.33-2.20%), P=0.96; MI, 0.96% (-2.35-4.27%), P=0.57; revascularization, -3.31% (-7.63-1.02%), P=0.13; SCAD recurrence, 3.75% (-2.05-9.55%), P=0.21; heart failure, -0.01% (-3.13-3.11%), P=0.99]. There was no significant heterogeneity across these studies.ConclusionPooled results suggest that SCAD patients initially managed with a conservative strategy may have similar in-hospital and long-term outcomes compared with those who received revascularization in the absence of ongoing ischemia or left main artery involvement. More data from prospective studies are warranted to validate these findings. © 2019 Italian Federation of Cardiology - I.F.C. All rights reserved.
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