TY - JOUR
T1 - Long-Term Outcomes Comparing Medical Therapy versus Revascularization for Spontaneous Coronary Artery Dissection
AU - Krittanawong, Chayakrit
AU - Nazir, Salik
AU - Hassan Virk, Hafeez
AU - Hahn, Joshua
AU - Wang, Zhen
AU - Fogg, Sonya E.
AU - Sharma, Samin K.
AU - Alam, Mahboob
AU - Jneid, Hani
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/7
Y1 - 2021/7
N2 - 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) versus invasive therapy (invasive therapy) (ie, percutaneous coronary intervention or coronary artery bypass grafting). The risk of death (risk ratio [RR] = 0.753; 95% confidence interval [CI]: 0.21-2.73; I2 = 21.1%; P = 0.61), recurrence of SCAD (RR = 1.09; 95% CI: 0.61-1.93; I2 = 0.0%; P = 0.74), and repeat revascularization (RR = 0.64; 95% CI: 0.21-1.94; 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 patients with SCAD treated with medical therapy compared with 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 are present. Further large-scale studies including randomized controlled trials are needed to confirm these findings.
AB - 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) versus invasive therapy (invasive therapy) (ie, percutaneous coronary intervention or coronary artery bypass grafting). The risk of death (risk ratio [RR] = 0.753; 95% confidence interval [CI]: 0.21-2.73; I2 = 21.1%; P = 0.61), recurrence of SCAD (RR = 1.09; 95% CI: 0.61-1.93; I2 = 0.0%; P = 0.74), and repeat revascularization (RR = 0.64; 95% CI: 0.21-1.94; 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 patients with SCAD treated with medical therapy compared with 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 are present. Further large-scale studies including randomized controlled trials are needed to confirm these findings.
KW - Meta-analysis
KW - Revascularization
KW - spontaneous coronary artery dissection (SCAD)
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85108055147&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85108055147&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2021.02.011
DO - 10.1016/j.amjmed.2021.02.011
M3 - Review article
C2 - 33773972
AN - SCOPUS:85108055147
SN - 0002-9343
VL - 134
SP - e403-e408
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 7
ER -