Key result
Initial conservative medical therapy for spontaneous coronary artery dissection was associated with lower overall mortality (OR 0.48; 95% CI 0.27-0.86; p=0.01) compared to an intervention strategy.
Why the study?
To compare clinical outcomes of spontaneous coronary artery dissection (SCAD) patients initially managed with medical therapy versus an interventional strategy.
Does medical therapy (conservative approach) reduce overall mortality and revascularization frequency in patients with spontaneous coronary artery dissection compared to an intervention strategy?
Meta-Analysis (n=2,577)
Does medical therapy (conservative approach) reduce overall mortality and revascularization frequency in patients with spontaneous coronary artery dissection compared to an intervention strategy?
A conservative medical approach for spontaneous coronary artery dissection is associated with lower overall mortality and need for further revascularization compared to an initial invasive strategy.
Conservative management associated with lower SCAD mortality; hypothesis-generating and leaves open randomized confirmation.
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.
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Brodovskaja et al. (2022) conducted a meta-analysis in Spontaneous coronary artery dissection (SCAD) (n=2,577). Conservative medical therapy vs. Intervention strategy was evaluated on Overall mortality (OR 0.48, 95% CI 0.27-0.86, p=0.01). Initial conservative medical therapy for spontaneous coronary artery dissection was associated with lower overall mortality (OR 0.48; 95% CI 0.27-0.86; p=0.01) compared to an intervention strategy.
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