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

Abstract

<h4>Introduction</h4>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.<h4>Evidence acquisition</h4>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 1^st, 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.<h4>Evidence synthesis</h4>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).<h4>Conclusions</h4>In conclusion, concomitant CS with SCAD was associated with worse outcomes than in the absence of CS.