Impact of cardiogenic shock on outcomes in patients with spontaneous coronary artery dissection: a systematic review and meta-analysis.

INTRODUCTION This systematic review evaluated patient characteristics and outcomes of patients presenting with concomitant spontaneous coronary artery dissection (SCAD) and cardiogenic shock (CS) compared with those without CS.

EVIDENCE ACQUISITION Data from four studies were analyzed. A comprehensive electronic literature search was performed by two authors using PubMed and Embase databases from inspection to February 1st, 2025. MeSH and broad terms including "Coronary Artery Dissection, Spontaneous" OR "SCAD" OR "Coronary Artery Dissection" were used with and without "Clinical Trials" as a search limit.

EVIDENCE SYNTHESIS SCAD patients presenting with CS were less likely to be females (OR=0.64, 95% CI: 0.44; 0.94) and have a history of myocardial infarction (OR=0.71, 95% CI: 0.51; 0.99) but more likely to have heart failure (OR=4.79, 95% CI: 3.30) and renal impairment (OR=2.23, 95% CI: 1.43; 3.50) than those without CS. The presence of CS was associated with longer hospital stay (MD=6.53 days, 95% CI: 5.20; 7.86) and worse in-hospital outcomes including death (OR=39.15, 95% CI: 4.73; 324.25), heart failure (OR=5.32, 95% CI: 2.73; 10.37), and stroke (OR=4.91, 95% CI: 2.44; 9.89).

CONCLUSIONS In conclusion, concomitant CS with SCAD was associated with worse outcomes than in the absence of CS.