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The role of secondary prevention implantable cardioverter-defibrillator (ICD) remains uncertain in spontaneous coronary artery dissection (SCAD) patients presenting with sudden cardiac arrest (SCA).
Objective
We aimed at assessing the outcomes following SCA and role of ICD therapy in SCAD.
Methods
The meta-analysis was performed using a meta-package for R version 4.0/RStudio version 1.2 and Freeman Tukey double arcsine method to establish the variance of raw proportions. The outcomes studied were-(1) incidence of ICD implantation;(2) appropriate and inappropriate ICD therapy;(3) SCAD recurrence and (4) incidence of recurrent SCA.
Results
Five studies, including=139 SCAD patients with SCA met study inclusion criteria. The mean age was 47.7±18.9 years, mean LVEF 43.8±10.8%, 88% were female (12% had pregnancy associated SCAD). Causes of SCA included ventricular arrhythmia (97.9%, n=136) and pulseless electrical activity (2.1%, n=3). Overall, 21.6% patients (95%CI 7.83-39%;I2=70%) received ICD implantation, of which 1.65% (95%CI 0-15.77;I2=0%) and 1.45% (95%CI 0-15.31%,I2=0%) patients received appropriate and inappropriate ICD therapies, respectively during follow-up period (4.1±3.3 years). Incidence of recurrent SCAD was 9% (95%CI 2.85-17.47%,I2=25%), and recurrent SCA was 7.5% patients (95% CI 0.10-21.25%,I2=70%). The pooled incidence of all-cause mortality was 2.6% (95% CI 0-8.18%,I2=17%).
Conclusion
Although ICD therapy intuitively makes sense, the risk-benefit ratio in SCAD patients remains unclear when the overall incidence of a recurrent event is low, with a favorable long-term prognosis.
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