In-hospital and long-term outcomes in spontaneous coronary artery dissection with concurrent cardiac arrest: Systematic review and meta-analysis

Background

Our understanding of factors predisposing patients with spontaneous coronary artery dissection (SCAD) to worse outcomes, such as concurrent sudden cardiac arrest (CA) and secondary prevention of sudden cardiac death in those patients, is limited.

Objective

We conducted the largest systematic review of studies assessing clinical outcomes in SCAD with concurrent CA.

Methods

This study was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane, and Scopus were searched using relevant search terms including “Spontaneous Coronary Artery Dissection,” “Ventricular Tachycardia,” “Ventricular Fibrillation,” “Sudden Cardiac Death,” and “Cardiac Arrest.” The search was conducted from database inception to January 2025.

Results

Out of 269 studies that underwent screening, 10 were included (n = 3978). In-hospital mortality, postdischarge mortality, recurrent myocardial infarction (MI) and recurrent SCAD occurred in 20%, 3%, 12%, and 9% of patients with SCAD and CA, respectively. When compared with patients with SCAD without CA, patients with SCAD and CA were at significantly higher risk of in-hospital mortality (risk ratio [RR] 6.7, 95% confidence interval [CI] 4.5–10.1, P < .00001), postdischarge mortality (RR = 5.9, 95% CI 1.7–19.9, P = .005), recurrent MI (RR = 3.3, 95% CI 2.0–5.4, P < .00001), and recurrent SCAD (RR = 1.9, 95% CI 1.1–3.3, P = .02). Out of a pooled 35 implanted cardiac defibrillators (ICDs) and wearable cardiac defibrillators (WCDs), there was only 1 appropriate and 1 inappropriate defibrillator discharge recorded over the follow-up period.

Conclusion

SCAD with concurrent CA is associated with worse in-hospital and long-term outcomes, although long-term rate of administered defibrillator therapies was low, supporting a conservative approach.