Medical treatment equal to invasive therapy for spontaneous
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Among patients with spontaneous coronary artery dissection, or SCAD, medical therapy was comparable to invasive therapy in long-term risk for death, recurrence and repeat revascularization, researchers reported.

“In this meta-analysis of 17 observational studies, we found no significant difference with regards to long-term risk of death, recurrent MI and recurrent SCAD between patients treated with medical therapy vs. invasive therapy for the management of nonatherosclerotic SCAD,” researchers wrote. “These findings support the current expert consensus that patients should be treated with medical therapy when clinically stable and no high-risk features present.”

High-risk patients, such as those with hemodynamic instability, persistent and worsening signs of myocardial ischemia, shock or malignant ventricular arrythmias, may benefit from invasive therapy in cases in which no other options were available, the researchers wrote.

In the study population of 1,369 patients, the mean age of the patients was 49 years, 82% were women, 860 were treated with medical therapy and the rest with invasive therapy and nearly 95% had ACS on presentation (91% with STEMI), the researchers wrote.

According to the researchers, those who had medical therapy and those who had invasive therapy did not differ in risk for death, recurrence of SCAD and repeat revascularization.

Researchers observed that many patients had comorbid conditions, including fibromuscular dysplasia, systemic lupus erythematosus, sarcoidosis, inflammatory bowel disease and celiac disease.

“Future multicenter randomized clinical trials evaluating invasive therapy vs. medical therapy are needed in patients presenting with SCAD in order to definitively evaluate superiority between invasive therapy and medical therapy for SCAD,” the researchers wrote.

Source: https://www.amjmed.com/article/S0002-9343(21)00167-4/abstract
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