Regional and temporal variations of spontaneous coronary artery dissection care according to consensus recommendations: a systematic review and meta-analysis

Quan Dang; Farrah Othman; Brodie Sheahen; Simone Marschner; Peter Psaltis; Rasha Kadem Al-Lamee; Richard Szirt; James Chong; Sarah Zaman

doi:10.1136/openhrt-2023-002379

Regional and temporal variations of spontaneous coronary artery dissection care according to consensus recommendations: a systematic review and meta-analysis

Open Heart. 2023 Dec 6;10(2):e002379. doi: 10.1136/openhrt-2023-002379.

Authors

Quan Dang¹, Farrah Othman^{2

3}, Brodie Sheahen¹, Simone Marschner¹, Peter Psaltis^{4

5

6}, Rasha Kadem Al-Lamee⁷, Richard Szirt⁸, James Chong⁹, Sarah Zaman^{10

9}

Affiliations

¹ Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia.
² The University of Western Australia, Perth, Western Australia, Australia.
³ Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia.
⁴ Vascular Research Centre, Lifelong Health Theme, South Australian Medical and Health Research Institute, Adelaide, South Australia, Australia.
⁵ Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
⁶ Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
⁷ National Heart and Lung Institute, Imperial College London, London, UK.
⁸ St George Hospital, Kogarah, New South Wales, Australia.
⁹ Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.
¹⁰ Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia sarah.zaman@sydney.edu.au.

Abstract

Aim: The first expert consensus documents on management of patients with spontaneous coronary artery dissection (SCAD) were published in 2018. Worldwide quality of care, as measured by adherence to these recommendations, has not been systematically reviewed. We aim to review the proportion of patients with SCAD receiving consensus recommendations globally, regionally and, determine differences in practice before and after 2018.

Methods and results: A systematic review was performed by searching four main databases (Medline, Embase, SCOPUS, CINAHL) from their inception to 16 June 2022. Studies were selected if they included patients with SCAD and reported at least one of the consensus document recommendations. 53 studies, n=8456 patients (mean 50.1 years, 90.6% female) were included. On random effects meta-analysis, 92.1% (95% CI 89.3 to 94.8) received at least one antiplatelet, 78.0% (CI 73.5 to 82.4) received beta-blockers, 58.7% (CI 52.3 to 65.1) received ACE inhibitors or aldosterone receptor blockers (ACEIs/ARBs), 54.4% (CI 45.4 to 63.5) were screened for fibromuscular dysplasia (FMD), and 70.2% (CI 60.8 to 79.5) were referred to cardiac rehabilitation. Except for cardiac rehabilitation referral and use of ACEIs/ARBs, there was significant heterogeneity in all other quality-of-care parameters, across geographical regions. No significant difference was observed in adherence to recommendations in studies published before and after 2018, except for lower cardiac rehabilitation referrals after 2018 (test of heterogeneity, p=0.012).

Conclusion: There are significant variations globally in the management of patients with SCAD, particularly in FMD screening. Raising awareness about consensus recommendations and further prospective evidence about their effect on outcomes may help improve the quality of care for these patients.

Keywords: Acute Coronary Syndrome; Cardiac Rehabilitation; Coronary Artery Disease.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Angiotensin Receptor Antagonists*
Angiotensin-Converting Enzyme Inhibitors
Consensus
Coronary Vessels*
Female
Humans
Male

Substances

Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors

Supplementary concepts

Coronary Artery Dissection, Spontaneous