Impact of cardiogenic shock on outcomes in patients with spontaneous coronary artery dissection: a systematic review and meta-analysis

Introduction Spontaneous coronary artery dissection (SCAD) is an underdiagnosed yet significant cause of myocardial infarction. While SCAD can lead to major adverse cardiovascular events and present with varying severity, the impact of cardiogenic shock (CS) on outcomes in these patients remains poorly defined. Given the rarity and complexity of this combined presentation, robust data are lacking. Purpose This systematic review and meta-analysis aims to evaluate patient characteristics and clinical outcomes of CS in patients with SCAD in comparison to SCAD patients without CS. Methods A systematic review was performed according to the Cochrane Handbook and the PRISMA statement. A systematic literature search was conducted using Embase and MEDLINE. RStudio software was used to calculate pooled odds ratios (OR) and mean differences (MD), with 95% confidence intervals (CI). A random-effects model was used due to anticipated heterogeneity. Sensitivity analyses were performed to account for potential overlapping among the national inpatient and national readmission databases. Results Data from four studies were analysed. SCAD patients presenting with CS were less likely to be female (OR 0.64, 95% CI: 0.44; 0.94, p=0.0239) or have had a prior myocardial infarction (OR 0.71, 95% CI: 0.51; 0.99, p=0.0443) than those without CS. However, they were more likely to have a history of heart failure (OR 4.79, 95% CI: 3.30; 6.96, p<0.0001) and renal impairment (OR 2.23, 95% CI: 1.43; 3.50, p=0.0005). In comparison with no CS, concomitant CS was associated with longer hospital stay (MD 6.53 days, 95% CI: 5.20; 7.86, p<0.0001) and worse in-hospital outcomes, including death (OR 39.15, 95% CI: 4.73; 324.25, p=0.0007), heart failure (OR 5.32, 95% CI: 2.73; 10.37, p<0.0001), and stroke (OR 4.91, 95% CI: 2.44; 9.89, p<0.0001). Sensitivity analyses showed comparable results. In addition, the 30-day readmission rate was significantly higher in SCAD patients presenting with CS (OR 2.02, 95% CI: 1.44; 2.83, p<0.0001) (Table 1). Conclusion(s) Concomitant CS in SCAD patients is associated with markedly worse clinic outcomes, including higher mortality, prolonged hospital stays, increased heart failure incidence, and greater 30-day readmission rates. These findings underscore the need for improved risk stratification and management strategies in this high-risk subgroup. Further prospective studies are essential to confirm these results.