Left Main Spontaneous Coronary Artery Dissection: Clinical Features, Management, and Outcomes
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: Clinical Features, Management, and Outcomes. JACC Cardiovasc Interv. Published 9 April 2025. doi:10.
Summarised from the published abstract; every number is checked against it