Abstract 15223: In-Hospital and Long-Term Clinical Outcomes of Spontaneous Coronary Artery Dissection Managed With Conservative versus Revascularization Strategy: A Meta-Analysis of Current Evidence

BackgroundOptimal treatment approach for spontaneous coronary artery dissection (SCAD) remains unclear.ObjectivesThe study aims to compare in-hospital and long-term clinical outcomes of SCAD patients initially managed with medical therapy (conservative approach) versus percutaneous coronary intervention or coronary artery bypass grafting (revascularization approach) based on published data.MethodsWe identified relevant studies by performing a systematic search in the Ovid MEDLINE® and Embase database. Studies that report in-hospital outcomes (death, myocardial infarction [MI], and urgent revascularization) or long-term outcomes (death, MI, target vessel revascularization [TVR], SCAD recurrence, and heart failure [HF]) were included and case reports were excluded. Risk difference (RD) between conservative and revascularization approach was estimated with the inverse variance-weighted method in a fixed-effect model.ResultsThe analysis includes 25 non-randomized studies totaling 1351 SCAD patients. The risk of in-hospital death or MI was comparable between two strategies. Conservative approach was associated with a lower risk of urgent revascularization compared with initial stenting or bypass surgery (RD=-6.32% [95% CI-10.95 to -1.69%]; P=0.007). There was no significant difference in long-term mortality (RD=-0.47% [-2.80 to 1.87%]; P=0.70), MI (RD=-0.08% [-3.54 to 3.38%]; P=0.96), TVR (RD=-4.01% [-8.72 to 0.70%]; P=0.09), SCAD recurrence (RD=3.21% [-3.46 to 9.88%]; P=0.35), or HF (RD=0.33% [-2.84 to 3.50%]; P=0.84).ConclusionsPooled results suggest that conservative and revascularization strategy may have similar in-hospital and long-term outcomes, except that SCAD patients managed conservatively had a lower risk of urgent revascularization. Prospective registries and randomized trials are required to validate these findings.Figure. In-hospital and long-term clinical outcomes of conservative (Rx) versus revascularization (Revasc) approach for SCAD