Coronary disease & ACSMeta-analysis
Left Main Spontaneous Coronary Artery Dissection
- Systematic review and pooled analysis of published case reports
Authors' conclusion
LM SCAD carried significant acute morbidity and mortality. Early revascularization (percutaneous coronary intervention or coronary artery bypass graft) was associated with a lower incidence of early adverse outcomes compared with conservative management, driven largely by reduction in recurrent MI and urgent MR.
Study context
- Population
- Patients with left main spontaneous coronary artery dissection (SCAD) (case reports in MEDLINE and Embase, 1990–2023)1,106 papers screened
- Participants
- 132 patients
- Comparison
- Early revascularization vs conservative management
Pooled result
As reported in the abstract
Clinical outcomes of LM SCAD · 120-day median follow-up
All-cause death
9%
LV assist device implantation or heart transplantation
4%
Recurrent myocardial infarction (MI)
13%
Urgent myocardial revascularization
21%
Further pooled results
| Outcome | adjusted HR (95% CI) | P value | |
|---|---|---|---|
| Composite of all-cause death, LV assist device or heart transplantation, recurrent MI and urgent myocardial revascularization | 0.37 (0.20–0.69) | P < 0.001 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Clinical features
- Mean age
- 40 ± 11 years
- Women
- 80%
- Occurred during pregnancy
- 36%
- Presented with ACS
- 95%
- Cardiogenic shock
- 22%
- Ventricular arrhythmias
- 8%
Original publication
Left Main Spontaneous Coronary Artery Dissection. JACC Cardiovasc Interv. Published 9 April 2025. doi:10.1016/j.jcin.2025.01.427
Summarised from the published abstract; every number is checked against it