Impact of ventricular arrhythmias on patients with spontaneous coronary artery dissection: a systematic review and meta-analysis.

INTRODUCTION

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction. Ventricular arrhythmias may complicate acute SCAD presentation but the impact of ventricular arrhythmias on clinical outcomes is not well-established. This systematic review aimed to compare characteristics and outcomes of SCAD patients with or without concomitant ventricular arrhythmias.

EVIDENCE ACQUISITION

A systematic literature search was conducted using PubMed and Embase databases. Odds ratio (OR) and mean difference (MD) with 95% confidence interval (95% CI) were computed using random-effects model.

EVIDENCE SYNTHESIS

Four studies enrolling 2365 SCAD patients were included. The pooled prevalence of ventricular arrhythmias was 9.0% (95% CI: 6.0; 14.0, I=87%) of patients with SCAD. Patients with ventricular arrhythmias were more likely to present with ST-segment elevation myocardial infarction (OR: 3.73, 95% CI: 2.50; 5.57, P<0.0001; I=0%) and to undergo percutaneous coronary intervention (OR: 2.07, 95% CI: 1.29; 3.32, P=0.0025; I=0%) than the entire SCAD cohort. They were more likely to have more in-hospital adverse events such as cardiac arrest (OR: 190.61, 95% CI: 4.39; 8275.52, P=0.0064; I=85%), death (OR: 6.35, 95% CI: 3.04; 13.27, P< 0.0001; I=0%), stroke (OR: 5.68, 95% CI: 2.00; 16.14, P=0.0011; I=0%), cardiogenic shock (OR: 17.44, 95% CI: 1.50; 203.06, P=0.0225; I=65%) and heart failure (OR: 6.98, 95% CI: 2.90; 16.81, P<0.0001; I=57%) than the entire SCAD cohort. In addition, they experienced more adverse events in terms of all-cause death (OR: 5.76, 95% CI: 1.30; 25.51, P=0.021; I=2%) and composite events (OR: 1.86, 95% CI: 1.07; 3.23, P=0.0267; I=0%) at a mean follow-up of 4.26 years.

CONCLUSIONS

SCAD patients with concurrent ventricular arrhythmias were more likely to experience in-hospital clinical adverse events such as cardiac arrest, stroke, cardiogenic shock, heart failure, and death than the entire SCAD cohort as well as more death and composite adverse events during follow-up.