Factors associated with recurrent spontaneous coronary artery dissection: a systematic review and meta-analysis

Abstract

BackgroundThe risk of recurrent spontaneous coronary artery dissection (SCAD) is a major concern to SCAD patients and clinicians. Identifying the high-risk subsets of recurrent SCAD remains an ongoing challenge. The meta-analysis aimed to assess the potential predictors for SCAD recurrence. Methods A literature search was performed in PubMed to collect studies that assessed potential factors associated with recurrence of SCAD among angiographically confirmed SCAD patients, including pregnancy, ventricular arrhythmia at presentation, history of hypertension, migraine, fibromuscular dysplasia (FMD), extracoronary vascular abnormalities (EVA), recent emotional or physical stress, and use of thienopyridine, beta-blocker, or statin. A meta-analytic approach was employed to estimate the relative risk (RR) with a 95% confidence interval (CI) by fitting random-effects models using the generic inverse variance weighted method. ResultsA total of 14 studies representing 4206 SCAD patients were included. Hypertension (RR, 1.49; 95% CI, 1.05-2.12; P = 0.0247) and FMD (RR, 2.02; 95% CI, 1.03-3.94; P = 0.0404) were associated with a greater risk of SCAD recurrence. The use of beta-blocker (RR, 0.51; 95% CI, 0.33-0.77; P = 0.0013) was associated with a lower risk of SCAD recurrence. Pregnancy, ventricular arrhythmia at presentation, migraine, EVA, recent emotional or physical stress, and use of thienopyridine or statin were not significantly associated with recurrent SCAD (P > 0.05).Conclusion SCAD patients with hypertension or FMD were at a higher risk of recurrence, whereas beta-blocker usage was related to a reduced risk. These findings may provide insights into risk prediction and management after the SCAD episode.

Spontaneous coronary artery dissection in patients with prior psychophysical stress: a systematic review of case reports and case series

“…Investigating the reasons behind this and finding susceptible patients is of utmost importance to reduce the associated morbidity and mortality and prevent unnecessary interventions and hospitalizations. In a meta-analysis by Gerald et al [138], hypertension and FMD were major stressors for recurrence. In our series, stress-related SCAD recurrences were associated with neither arterial hypertension nor FMD.…”

Pathophysiology of spontaneous coronary artery dissection: hematoma, not thrombus

“…Remarkably, most of these women managed pregnancy and lactation without any evidence of an increased risk of SCAD recurrence compared to women with a history of SCAD who did not become pregnant (44). Furthermore, in a meta-analysis involving 4,206 SCAD patients, pregnancy did not exhibit a significant association with recurrent SCAD (45).…”

What Is New in Spontaneous Coronary Artery Dissection?

“… 56 A meta-analysis of 14 studies, comprised of 4206 patients, examining factors associated with recurrence of SCAD, showed that hypertension (risk ratio [RR] 1.49) and FMD (RR 2.02) conferred a greater risk. 57 By contrast, the use of beta-blockers (RR 0.51) was associated with a reduced risk of SCAD recurrence. In the recently published 3-year outcomes of the Canadian SCAD Cohort Study, recurrent de novo SCAD was seen in 2.4% of patients, and recurrent MI was seen in 5.7%.…”