Medical treatment

Medical treatment equal to invasive therapy for spontaneous coronary artery dissection

April 09, 2021

1 minute read


Disclosures: The authors report no relevant financial information.

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Among patients with spontaneous coronary artery dissection, or SCAD, medical treatment was comparable to invasive treatment in terms of the long-term risk of death, recurrence and repeated revascularization, the researchers reported.

Chayakrit Krittanawong

“In our meta-analysis of 17 observational studies, we found no significant difference in the long-term risk of death, recurrent MI and recurrent SCAD between patients treated with medical therapy compared to an invasive treatment for the management of non-atherosclerotic SCAD”, Chayakrit Krittanawong, MD, cardiology fellow at Baylor College of Medicine, and colleagues wrote. “These results support the current expert consensus that patients should be treated with medical therapy when they are clinically stable and no high-risk features are present.”

Among patients with SCAD, medical therapy was comparable to invasive therapy in terms of the long-term risk of death, recurrence, and repeated revascularization. Data are from Krittanawong C, et al. Am J Med. 2021; doi:10.1016/j.amjmed.2021.02.011.

High-risk patients, such as those with hemodynamic instability, persistent and worsening signs of myocardial ischemia, shock, or malignant ventricular arrhythmias, may benefit from invasive therapy in cases where no other options were available , the researchers wrote.

In the study population of 1369 patients, the mean patient age was 49 years, 82% were female, 860 were treated with medical therapy and the remainder with invasive therapy, and nearly 95% had ACS at presentation ( 91% with STEMI), the researchers wrote.

According to the researchers, those who underwent medical treatment and those who underwent invasive treatment did not differ in terms of the risk of death (RR = 0.753; 95% CI, 0.21-2.73; I2 = 21.1%; P = 0.61), recurrence of SCAD (RR = 1.09; 95% CI, 0.61-1.93; I2 = 0%; P = 0.74) and repeated revascularization (RR = 0.64; 95% CI: 0.21-1.94; I2 = 57.6%; P = 0.38).

The researchers observed that many patients suffered from comorbid diseases, including fibromuscular dysplasia, systemic lupus erythematosus, sarcoidosis, inflammatory bowel disease and celiac disease.

“Future multicenter randomized clinical trials evaluating invasive therapy versus medical therapy are needed in patients with SCAD to definitively assess the superiority between invasive therapy and medical therapy for SCAD,” the researchers wrote.