Outcomes during the first year following spontaneous coronary artery dissection: A systematic timeframe pooled analysis

• Published in: Catheterization and cardiovascular interventions Vol. 99; no. 2; pp. 472 - 479
• Main Authors: Bocchino, Pier Paolo, Franchin, Luca, Angelini, Filippo, D'Ascenzo, Fabrizio, De Ferrari, Gaetano Maria, Alfonso, Fernando
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.02.2022
• Subjects: acute myocardial infarction; Congestive heart failure; Coronary Angiography; Coronary artery; coronary artery disease; Coronary Vessel Anomalies - diagnostic imaging; Coronary Vessel Anomalies - epidemiology; Coronary Vessel Anomalies - therapy; Coronary vessels; Humans; Myocardial infarction; Patients; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Risk Factors; Treatment Outcome; Vascular Diseases - therapy; coronary artery disease; percutaneous coronary intervention; acute myocardial infarction
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.30016

Objectives We aimed to compare the incidence and timing of major adverse cardiovascular events (MACE) within the first year after spontaneous coronary artery dissection (SCAD) according to the management strategy: conservative versus invasive. Background Treatment of SCAD remains controversial. Methods A pooled analysis of studies providing separate individual clinical outcomes for conservative and invasive treatment strategies within 1 year after SCAD was performed. The primary outcome measure was MACE incidence within three predefined study periods after SCAD, namely “in‐hospital”, “discharge‐to‐6‐months” and “6‐to‐12‐months”. MACE was defined as a composite of all‐cause death, myocardial infarction, target vessel revascularization, heart failure and SCAD recurrence. Results A total of 16 studies (444 patients) were included; 277 (62%) patients were treated conservatively and 167 (38%) invasively. Within 1‐year follow‐up, 39 (67%) MACE occurred during the in‐hospital period compared to 10 (17%) in the “discharge‐to‐6 months” period and 9 (16%) in the “6‐to‐12‐months” period (p < 0.0001 for the overall comparison). MACE incidence was also significantly different between the three study periods in the conservatively‐treated group (23 [78%] vs. 7 [23%] vs. 0 [0%], respectively; p < 0.0001) and the invasively‐treated group (12 [66%] vs. 3 [17%] vs. 3 [17%], respectively; p < 0.0001), although no significant difference was found regarding MACE incidence in the intra‐period comparisons between conservative and invasive treatment strategies. Conclusions This pooled analysis showed that most MACE following SCAD occurred during the in‐hospital period compared to the following two semesters, regardless of the treatment strategy. No difference regarding MACE incidence was found between conservative and invasive strategies in each study period.