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In-hospital and long-term outcomes in spontaneous coronary artery dissection with concurrent cardiac arrest:

Omar Baqal1, Suganya A Karikalan1,2, Elfatih A Hasabo3,4

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA.

Heart Rhythm O2
|July 28, 2025
PubMed

Insights

Spontaneous coronary artery dissection (SCAD) with cardiac arrest (CA) leads to significantly worse outcomes. Despite higher mortality and recurrence risks, defibrillator use was low, suggesting a conservative management approach for SCAD patients experiencing CA.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Critical Care Medicine

Background:

  • Limited understanding exists regarding factors influencing outcomes in spontaneous coronary artery dissection (SCAD) patients, particularly those experiencing concurrent cardiac arrest (CA).
  • Secondary prevention strategies for sudden cardiac death in SCAD patients with CA require further elucidation.

Purpose of the Study:

  • To conduct the largest systematic review assessing clinical outcomes in patients with SCAD and concurrent CA.
  • To compare outcomes between SCAD patients with and without CA.

Main Methods:

  • Systematic review adhering to PRISMA guidelines.
  • Searches of PubMed, Cochrane, and Scopus databases for studies on SCAD and CA from inception to January 2025.
  • Inclusion of 10 studies encompassing 3978 patients.

Main Results:

  • SCAD with CA patients showed significantly higher in-hospital mortality (RR 6.7) and postdischarge mortality (RR 5.9) compared to SCAD without CA.
  • Recurrent myocardial infarction (MI) (RR 3.3) and recurrent SCAD (RR 1.9) were also significantly more frequent in SCAD with CA patients.
  • Low rates of appropriate defibrillator discharge (1/35) were observed in patients with implanted cardiac defibrillators (ICDs) or wearable cardiac defibrillators (WCDs).

Conclusions:

  • Spontaneous coronary artery dissection (SCAD) concurrent with cardiac arrest (CA) is linked to adverse in-hospital and long-term outcomes.
  • The low incidence of defibrillator therapies suggests a conservative management strategy may be appropriate for SCAD patients who experience CA.
Abstract

Keywords:
Cardiac arrestDefibrillationImplantable cardiac defibrillatorMyocardial infarctionSpontaneous coronary artery dissectionSudden cardiac deathVentricular arrhythmiaVentricular fibrillationVentricular tachycardiaWearable cardiac defibrillator

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