Abstract 4146703: Conservative versus invasive management of spontaneous coronary artery dissection: A meta-analysis of 7197 patients

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.