Conservative versus invasive management of spontaneous coronary artery dissection: A meta-analysis of 7197 patients
Abstract Body (Do not enter title and authors here): Background: Spontaneous coronary artery dissection (SCAD) is defined as a separation of the coronary arterial wall caused by intramural bleeding that is neither traumatic, iatrogenic, nor atherosclerotic. It is now recognized as a significant cause of acute coronary syndrome (ACS), particularly in young women. There is conflicting information regarding the acute therapy of SCAD. We aimed to summarize the available evidence and provide a comprehensive analysis of the management of SCAD. Methods: We systemically examined the clinical outcomes of conservative and invasive management of patients with SCAD using medical records from Web of Science, PUBMED, Scopus, and Cochrane. Our outcomes of interest were all-cause mortality, non-fetal myocardial infarction (MI), and target vessel revascularization (TLR). Risk ratios (RR) and 95% CI were used in a random-effects model to analyze the data. Results: A total of 27 studies were included in this meta-analysis, with a total sample size of 7,197. The conservative approach was associated with a reduction in all-cause mortality compared to the invasive method (RR = 0.29, 95% CI [0.20, 0.42], P < 0.001), and non-fetal MI (RR = 0.74, 95% CI [0.55, 0.99], P = 0.04). Moreover, the conservative approach was associated with a reduced incidence of TLR over the invasive approach (RR = 0.53, 95% CI [0.37, 0.77], P = 0.009). Conclusion: Conservative management of patients with SCAD showed better clinical outcomes than invasive management. We detected lower rates of death, myocardial infarction, and target vessel revascularization among the conservatively managed group, which suggests that conservative therapy should be the first-line approach for patients with SCAD.
Abdelaziz, Ahmed
( Faculty of medicine, Al Azhar university, Cairo, Egypt
, Cairo
, Egypt
)
Banour, Sandi
( ruby hospital
, Verginia
, Virginia
, United States
)
Abdelazeem, Basel
( West Virginia University
, Morgantown
, West Virginia
, United States
)
Gadelmawla, Ahmed Farid
( Faculty of Medicine, Menoufia Unive
, Menoufia
, Egypt
)
Helmi, Ahmed
( Faculty of Medicine, Alexandria Uni
, Alexandria
, Egypt
)
Diaa, Ahmed
( Faculty of medicine, Al Azhar university, Cairo, Egypt
, Cairo
, Egypt
)
Ibrahim, Rahma
( Faculty of Medicine, Kafr Elsheikh University
, Kafr Elsheikh
, Egypt
)
Mohamed, Ahmed
( Faculty of medicine, Tanta university
, El mahallah e kobra
, Egypt
)
Afify, Raneem
( Facylty of medicine, Tanta universi
, El mahallah el kobra
, Egypt
)
Desouki, Mariam
( Faculty of Medicine, Alexandria Uni
, Alexandria
, Egypt
)
Nasr, Ahmed
( Damietta faculty of medicine, Al-Azher university
, Clifton
, New Jersey
, United States
)
Author Disclosures:
Ahmed Abdelaziz:DO NOT have relevant financial relationships
| Sandi Banour:DO NOT have relevant financial relationships
| Basel Abdelazeem:DO NOT have relevant financial relationships
| Ahmed Farid Gadelmawla:DO NOT have relevant financial relationships
| Ahmed Helmi:DO NOT have relevant financial relationships
| Ahmed Diaa:DO NOT have relevant financial relationships
| Rahma Ibrahim:DO NOT have relevant financial relationships
| Ahmed Mohamed:DO NOT have relevant financial relationships
| Raneem Afify:DO NOT have relevant financial relationships
| Mariam Desouki:DO NOT have relevant financial relationships
| Ahmed Nasr:DO NOT have relevant financial relationships
