Impact of ventricular arrhythmias on patients with spontaneous coronary artery dissection: a systematic review and meta-analysis.

IF 4.3 4区医学 0 MEDICINE, GENERAL & INTERNAL

Panminerva medica Pub Date : 2025-07-02 DOI:10.23736/S0031-0808.25.05340-6

Rasha Kaddoura, Ashraf Ahmed, Mirvat Al-Asnag, Asysha F Cader, Mohammed Al-Hijji

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引用次数: 0

Abstract

Introduction: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction. Ventricular arrhythmias may complicate acute SCAD presentation but the impact of ventricular arrhythmias on clinical outcomes is not well-established. This systematic review aimed to compare characteristics and outcomes of SCAD patients with or without concomitant ventricular arrhythmias.

Evidence acquisition: A systematic literature search was conducted using PubMed and Embase databases. Odds ratio (OR) and mean difference (MD) with 95% confidence interval (95% CI) were computed using random-effects model.

Evidence synthesis: Four studies enrolling 2365 SCAD patients were included. The pooled prevalence of ventricular arrhythmias was 9.0% (95% CI: 6.0; 14.0, I²=87%) of patients with SCAD. Patients with ventricular arrhythmias were more likely to present with ST-segment elevation myocardial infarction (OR: 3.73, 95% CI: 2.50; 5.57, P<0.0001; I²=0%) and to undergo percutaneous coronary intervention (OR: 2.07, 95% CI: 1.29; 3.32, P=0.0025; I²=0%) than the entire SCAD cohort. They were more likely to have more in-hospital adverse events such as cardiac arrest (OR: 190.61, 95% CI: 4.39; 8275.52, P=0.0064; I²=85%), death (OR: 6.35, 95% CI: 3.04; 13.27, P< 0.0001; I²=0%), stroke (OR: 5.68, 95% CI: 2.00; 16.14, P=0.0011; I²=0%), cardiogenic shock (OR: 17.44, 95% CI: 1.50; 203.06, P=0.0225; I²=65%) and heart failure (OR: 6.98, 95% CI: 2.90; 16.81, P<0.0001; I²=57%) than the entire SCAD cohort. In addition, they experienced more adverse events in terms of all-cause death (OR: 5.76, 95% CI: 1.30; 25.51, P=0.021; I²=2%) and composite events (OR: 1.86, 95% CI: 1.07; 3.23, P=0.0267; I²=0%) at a mean follow-up of 4.26 years.

Conclusions: SCAD patients with concurrent ventricular arrhythmias were more likely to experience in-hospital clinical adverse events such as cardiac arrest, stroke, cardiogenic shock, heart failure, and death than the entire SCAD cohort as well as more death and composite adverse events during follow-up.

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室性心律失常对自发性冠状动脉夹层患者的影响：一项系统回顾和荟萃分析。

自发性冠状动脉夹层（SCAD）是一种越来越被认可的心肌梗死原因。室性心律失常可能使急性SCAD的表现复杂化，但室性心律失常对临床结果的影响尚不明确。本系统综述旨在比较伴有或不伴有室性心律失常的SCAD患者的特征和预后。证据获取：使用PubMed和Embase数据库进行系统的文献检索。采用随机效应模型计算95%置信区间（95% CI）的优势比（OR）和平均差（MD）。证据综合：纳入了4项研究，纳入了2365例SCAD患者。室性心律失常的总患病率为9.0% (95% CI: 6.0；14.0, I2=87%)。室性心律失常患者更容易出现st段抬高型心肌梗死(OR: 3.73, 95% CI: 2.50；5.57, P2=0%)和经皮冠状动脉介入治疗(OR: 2.07, 95% CI: 1.29；3.32, P = 0.0025;I2=0%)高于整个SCAD队列。他们更有可能出现更多的院内不良事件，如心脏骤停(OR: 190.61, 95% CI: 4.39；8275.52, P = 0.0064;I2=85%)，死亡(OR: 6.35, 95% CI: 3.04；13.27, p < 0.0001；I2=0%)，卒中(OR: 5.68, 95% CI: 2.00；16.14, P = 0.0011;I2=0%)、心源性休克(OR: 17.44, 95% CI: 1.50；203.06, P = 0.0225;I2=65%)和心力衰竭(OR: 6.98, 95% CI: 2.90；16.81, P2=57%)高于整个SCAD队列。此外，就全因死亡而言，他们经历了更多的不良事件(OR: 5.76, 95% CI: 1.30；25.51, P = 0.021;I2=2%)和综合事件(OR: 1.86, 95% CI: 1.07；3.23, P = 0.0267;I2=0%)，平均随访4.26年。结论：合并室性心律失常的SCAD患者比整个SCAD队列更容易出现院内临床不良事件，如心脏骤停、卒中、心源性休克、心力衰竭和死亡，并且在随访期间出现更多的死亡和复合不良事件。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Panminerva medica 医学-医学：内科

CiteScore

5.00

自引率

2.30%

发文量

199

审稿时长

>12 weeks

期刊介绍： Panminerva Medica publishes scientific papers on internal medicine. Manuscripts may be submitted in the form of editorials, original articles, review articles, case reports, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work. Duties and responsibilities of all the subjects involved in the editorial process are summarized at Publication ethics. Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (ICMJE).