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

Abstract

BACKGROUND:

The 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.

RESULTS:

A 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.

• Authors: Gerald Chi, Homa Najafi, Sahar Memar Montazerin, Jane J Lee
• Journal: Coronary artery disease (Coron Artery Dis) Vol. 33 Issue 7 Pg. 566-573 (11 01 2022) ISSN: 1473-5830 [Electronic] England
• PMID: 35866498 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Adrenergic beta-Antagonists
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Thienopyridines

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Coronary Angiography (methods)
• Coronary Vessel Anomalies (complications, diagnostic imaging, epidemiology)
• Coronary Vessels
• Female
• Fibromuscular Dysplasia
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Hypertension
• Migraine Disorders (complications)
• Pregnancy
• Risk Factors
• Thienopyridines
• Vascular Diseases (complications, congenital, diagnostic imaging, epidemiology)