Long-Term Outcomes Comparing Medical Therapy versus Revascularization for Spontaneous Coronary Artery Dissection (original) (raw)

The American Journal of Medicine, 2021

Abstract

The ideal management of spontaneous coronary artery dissection (SCAD) has yet to be clearly defined. We conducted a comprehensive search of Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception from 1966 through September 2020 for all original studies (randomized controlled trials and observational studies) that evaluated patients with SCAD. Study groups were defined by allocation to medical therapy (medical therapy) vs invasive therapy (invasive therapy) (i.e., percutaneous coronary intervention or coronary artery bypass grafting). The risk of death (RR= 0.753, 95% CI: 0.21 to 2.73; I2= 21.1%, p=0.61), recurrence of SCAD (RR=1.09; 95% CI: 0.61 to 1.93; I2=0.0%, p=0.74), and repeat revascularization (RR=0.64; 95% CI: 0.21 to 1.94; I2= 57.6%; p=0.38) were not statistically different between medical therapy and invasive therapy for a follow up ranging from 4 months to 3 years. In conclusion, in this meta-analysis of observational studies, the long-term risk of death, recurrent SCAD, and repeat revascularization did not significantly differ among SCAD patient treated with medical therapy compared to those treated with invasive therapy. These findings support the current expert consensus that patients should be treated with medical therapy when clinically stable and no high-risk features present. Further large-scale studies including RCTs are needed to confirm these findings.

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