Baqal Omar, Karikalan Suganya A, Hasabo Elfatih A, Tareen Haseeb, Futela Pragyat, Qasba Rakhtan K, Shafqat Areez, Qasba Ruman K, Hayes Sharonne N, Tweet Marysia S, El Masry Hicham Z, Lee Kwan S, Shen Win-Kuang, Sorajja Dan
Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA.
CHRISTUS Good Shepherd Medical Center, Longview, Texas, USA.
Heart Rhythm O2. 2025 Apr 24;6(6):843-853. doi: 10.1016/j.hroo.2025.03.023. eCollection 2025 Jun.
Our understanding of factors predisposing patients with spontaneous coronary artery dissection (SCAD) to worse outcomes, such as concurrent sudden cardiac arrest (CA) and secondary prevention of sudden cardiac death in those patients, is limited.
We conducted the largest systematic review of studies assessing clinical outcomes in SCAD with concurrent CA.
This study was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane, and Scopus were searched using relevant search terms including "Spontaneous Coronary Artery Dissection," "Ventricular Tachycardia," "Ventricular Fibrillation," "Sudden Cardiac Death," and "Cardiac Arrest." The search was conducted from database inception to January 2025.
Out of 269 studies that underwent screening, 10 were included (n = 3978). In-hospital mortality, postdischarge mortality, recurrent myocardial infarction (MI) and recurrent SCAD occurred in 20%, 3%, 12%, and 9% of patients with SCAD and CA, respectively. When compared with patients with SCAD without CA, patients with SCAD and CA were at significantly higher risk of in-hospital mortality (risk ratio [RR] 6.7, 95% confidence interval [CI] 4.5-10.1, < .00001), postdischarge mortality (RR = 5.9, 95% CI 1.7-19.9, = .005), recurrent MI (RR = 3.3, 95% CI 2.0-5.4, < .00001), and recurrent SCAD (RR = 1.9, 95% CI 1.1-3.3, = .02). Out of a pooled 35 implanted cardiac defibrillators (ICDs) and wearable cardiac defibrillators (WCDs), there was only 1 appropriate and 1 inappropriate defibrillator discharge recorded over the follow-up period.
SCAD with concurrent CA is associated with worse in-hospital and long-term outcomes, although long-term rate of administered defibrillator therapies was low, supporting a conservative approach.
我们对导致自发性冠状动脉夹层（SCAD）患者预后较差的因素的理解有限，比如并发心脏骤停（CA）以及这些患者心脏性猝死的二级预防。
我们对评估并发CA的SCAD患者临床结局的研究进行了最大规模的系统评价。
本研究按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行。使用包括“自发性冠状动脉夹层”“室性心动过速”“心室颤动”“心脏性猝死”和“心脏骤停”等相关检索词在PubMed、Cochrane和Scopus数据库进行检索。检索从各数据库建库至2025年1月。
在接受筛选的269项研究中，纳入了10项（n = 3978）。并发CA的SCAD患者的院内死亡率、出院后死亡率、复发性心肌梗死（MI）和复发性SCAD的发生率分别为20%、3%、12%和9%。与无CA的SCAD患者相比，并发CA的SCAD患者的院内死亡风险（风险比[RR] 6.7，95%置信区间[CI] 4.5 - 10.1，P <.00001）、出院后死亡风险（RR = 5.9，95% CI 1.7 - 19.9，P =.005）、复发性MI风险（RR = 3.3，95% CI 2.0 - 5.4，P <.00001）和复发性SCAD风险（RR = 1.9，95% CI 1.1 - 3.3，P =.02）显著更高。在汇总的35台植入式心脏除颤器（ICD）和可穿戴式心脏除颤器（WCD）中，随访期间仅记录到1次恰当的和1次不恰当的除颤器放电。
并发CA的SCAD与更差的院内和长期结局相关，尽管除颤器治疗的长期使用率较低，这支持了一种保守的治疗方法。
