Key result
Concomitant ventricular arrhythmias in SCAD patients were associated with increased in-hospital death (OR 6.35; 95% CI 3.04-13.27; P<0.0001) and other adverse events compared to the overall cohort.
Why the study?
Ventricular arrhythmias can complicate acute SCAD presentation, but their impact on clinical outcomes was not well-established.
Do concomitant ventricular arrhythmias worsen clinical outcomes in patients with spontaneous coronary artery dissection?
Meta-Analysis (n=2,365)
Do concomitant ventricular arrhythmias worsen clinical outcomes in patients with spontaneous coronary artery dissection?
Ventricular arrhythmias in SCAD patients are associated with a significantly increased risk of in-hospital and long-term adverse events, including death.
SCAD patients with ventricular arrhythmias warrant closer monitoring for mortality risk; extends observational data but leaves optimal management strategies open.
INTRODUCTION: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction. Ventricular arrhythmias may complicate acute SCAD presentation but the impact of ventricular arrhythmias on clinical outcomes is not well-established. This systematic review aimed to compare characteristics and outcomes of SCAD patients with or without concomitant ventricular arrhythmias.EVIDENCE ACQUISITION: A systematic literature search was conducted using PubMed and Embase databases. Odds ratio (OR) and mean difference (MD) with 95% confidence interval (95% CI) were computed using random-effects model.EVIDENCE SYNTHESIS: Four studies enrolling 2365 SCAD patients were included. The pooled prevalence of ventricular arrhythmias was 9.0% (95% CI: 6.0; 14.0, I2=87%) of patients with SCAD. Patients with ventricular arrhythmias were more likely to present with ST-segment elevation myocardial infarction (OR: 3.73, 95% CI: 2.50; 5.57, P<0.0001; I2=0%) and to undergo percutaneous coronary intervention (OR: 2.07, 95% CI: 1.29; 3.32, P=0.0025; I2=0%) than the entire SCAD cohort. They were more likely to have more in-hospital adverse events such as cardiac arrest (OR: 190.61, 95% CI: 4.39; 8275.52, P=0.0064; I2=85%), death (OR: 6.35, 95% CI: 3.04; 13.27, P< 0.0001; I2=0%), stroke (OR: 5.68, 95% CI: 2.00; 16.14, P=0.0011; I2=0%), cardiogenic shock (OR: 17.44, 95% CI: 1.50; 203.06, P=0.0225; I2=65%) and heart failure (OR: 6.98, 95% CI: 2.90; 16.81, P<0.0001; I2=57%) than the entire SCAD cohort. In addition, they experienced more adverse events in terms of all-cause death (OR: 5.76, 95% CI: 1.30; 25.51, P=0.021; I2=2%) and composite events (OR: 1.86, 95% CI: 1.07; 3.23, P=0.0267; I2=0%) at a mean follow-up of 4.26 years.CONCLUSIONS: SCAD patients with concurrent ventricular arrhythmias were more likely to experience in-hospital clinical adverse events such as cardiac arrest, stroke, cardiogenic shock, heart failure, and death than the entire SCAD cohort as well as more death and composite adverse events during follow-up.
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Kaddoura et al. (2025) conducted a meta-analysis in Spontaneous coronary artery dissection (SCAD) (n=2,365). Ventricular arrhythmias vs. Entire SCAD cohort was evaluated on In-hospital death (OR 6.35, 95% CI 3.04-13.27, p=<0.0001). Concomitant ventricular arrhythmias in SCAD patients were associated with increased in-hospital death (OR 6.35; 95% CI 3.04-13.27; P<0.0001) and other adverse events compared to the overall cohort.
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