Pier Paolo Bocchino1, Filippo Angelini2, Luca Franchin2, Fabrizio D'Ascenzo2, Federico Fortuni3, Ovidio De Filippo2, Federico Conrotto2, Fernando Alfonso4, Jacqueline Saw5, Javier Escaned6, Chengwei Liu7, Gaetano Maria De Ferrari2. 1. Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy. Electronic address: pierpaolo1991@gmail.com. 2. Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy. 3. Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy. 4. Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBER-CV, Madrid, Spain. 5. Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada. 6. Unidad de Cardiología Intervencionista, Hospital Clínico San Carlos, Madrid, Spain. 7. Department of Cardiology, Wuhan Asia Hospital, Wuhan University of Science and Technology, Wuhan, China.
Abstract
BACKGROUND: Data regarding the best treatment for spontaneous coronary artery dissection (SCAD) are limited. The aim of the present study was to compare the clinical outcomes of conservative versus invasive treatment in SCAD patients. METHODS: We systematically searched the literature for studies evaluating the comparative efficacy and safety of invasive revascularization versus medical therapy for the treatment of SCAD from 1990 to 2020. The study endpoints were all-cause death, cardiovascular death, myocardial infarction, heart failure, SCAD recurrence and target vessel revascularization (TVR) rates. Random effect meta-analysis was performed by comparing the clinical outcomes between the two groups. A univariate meta-regression analysis was also performed. RESULTS: Twenty-four observational studies with 1720 patients were included. After 28 ± 14 months, a conservative approach was associated with lower TVR rate compared with invasive treatment (OR = 0.50; 95%CI 0.28-0.90; P = 0.02). No statistical difference was found regarding all-cause death (OR = 0.81; 95%CI 0.31-2.08; P = 0.66), cardiovascular death (OR = 0.89; 95%CI 0.15-5.40; P = 0.89), myocardial infarction (OR = 0.95; 95%CI 0.50-1.81; P = 0.87), heart failure (OR 0.96; 95%CI 0.41-2.22; P = 0.92) and SCAD recurrence (OR = 0.94; 95%CI 0.52-1.72; P = 0.85). The meta-regression analysis suggested that male gender, diabetes mellitus, smoking habit, prior coronary artery disease, left main coronary artery involvement, lower ejection fraction and low TIMI flow at admission were related with high overall mortality, whereas SCAD recurrence was higher among patients with fibromuscular dysplasia. CONCLUSIONS: A conservative approach was associated with similar clinical outcomes and lower TVR rates compared with an invasive strategy in SCAD patients; future prospective studies are needed to confirm these results.
BACKGROUND: Data regarding the best treatment for spontaneous coronary artery dissection (SCAD) are limited. The aim of the present study was to compare the clinical outcomes of conservative versus invasive treatment in SCAD patients. METHODS: We systematically searched the literature for studies evaluating the comparative efficacy and safety of invasive revascularization versus medical therapy for the treatment of SCAD from 1990 to 2020. The study endpoints were all-cause death, cardiovascular death, myocardial infarction, heart failure, SCAD recurrence and target vessel revascularization (TVR) rates. Random effect meta-analysis was performed by comparing the clinical outcomes between the two groups. A univariate meta-regression analysis was also performed. RESULTS: Twenty-four observational studies with 1720 patients were included. After 28 ± 14 months, a conservative approach was associated with lower TVR rate compared with invasive treatment (OR = 0.50; 95%CI 0.28-0.90; P = 0.02). No statistical difference was found regarding all-cause death (OR = 0.81; 95%CI 0.31-2.08; P = 0.66), cardiovascular death (OR = 0.89; 95%CI 0.15-5.40; P = 0.89), myocardial infarction (OR = 0.95; 95%CI 0.50-1.81; P = 0.87), heart failure (OR 0.96; 95%CI 0.41-2.22; P = 0.92) and SCAD recurrence (OR = 0.94; 95%CI 0.52-1.72; P = 0.85). The meta-regression analysis suggested that male gender, diabetes mellitus, smoking habit, prior coronary artery disease, left main coronary artery involvement, lower ejection fraction and low TIMI flow at admission were related with high overall mortality, whereas SCAD recurrence was higher among patients with fibromuscular dysplasia. CONCLUSIONS: A conservative approach was associated with similar clinical outcomes and lower TVR rates compared with an invasive strategy in SCAD patients; future prospective studies are needed to confirm these results.
Authors: Serigne Cheikh Tidiane Ndao; Amer Zabalawi; Mame Madjiguène Ka; Khadidiatou Dia; Waly N Mboup; Djibril M Ba; Laurent L P Payot; Régis T Delaunay; Pape D Fall; Mouhamed Cherif Mboup Journal: Am J Case Rep Date: 2021-12-25