Heart Diagram

Medical therapy comparable to intervention in spontaneous coronary artery dissection (SCAD)

By Ahmed El-Medany

A meta-analysis by Krittanawong et al found no significant difference to long-term risk of death, recurrent myocardial infarction (MI) and SCAD, and repeat revascularisation.

The researchers stated that high-risk patients, including those with hemodynamic instability, persistent and worsening signs of myocardial ischemia, and shock or malignant ventricular arrythmias, may benefit from invasive therapy in cases in which no other options were available.
In the study population of 1,369 patients, with a mean age of 49 years, 82% were women, 860 were treated with medical therapy, and the remainder managed with invasive therapy, and nearly 95% presented with ACS (91% with STEMI).

According to the researchers, those who had medical therapy and those who had invasive therapy did not differ in risk for death (Relative risk (RR) = 0.753; 95% confidence interval (CI), 0.21-2.73; I2 = 21.1%; P = .61), recurrence of SCAD (RR = 1.09; 95% CI, 0.61-1.93; I2 = 0%; P = .74) and repeat revascularization (RR = 0.64; 95% CI: 0.21-1.94; I2 = 57.6%; P = .38).
Comorbid conditions included fibromuscular dysplasia, systemic lupus erythematosus, sarcoidosis, inflammatory bowel disease, and coeliac disease.

“Future multicentre randomized clinical trials evaluating invasive therapy vs. medical therapy are needed in patients presenting with SCAD in order to definitively evaluate superiority between invasive therapy and medical therapy for SCAD,” the researchers wrote.

Read more at: https://www.amjmed.com/article/S0002-9343(21)00167-4/abstract

Source: Krittanawong C, Nazir S, Virk HH, Hahn J, Wang Z, Fogg SE, Sharma SK, Alam M, Jneid H. Long-Term Outcomes Comparing Medical Therapy versus Revascularization for Spontaneous Coronary Artery Dissection: A Systematic Review and Meta-Analysis. The American Journal of Medicine. 2021 Mar 25.