Antiplatelet Therapy Following Spontaneous Coronary Artery Dissection: Systemic Review

Abstract

AbstractBackgroundSpontaneous coronary artery dissection (SCAD) is an understudied cause of acute coronary syndrome (ACS), particularly in women. Heart muscle damage may result from spontaneous dissection of coronary arteries. There is no clear consensus regarding the optimum antiplatelet medication regimen and treatment duration for SCAD despite current American Heart Association (AHA) consensus guidelines recommending 12-month regimen of dual antiplatelet therapy (DAPT) consisting of a P2Y12inhibitor and aspirin for patients following myocardial infarction (MI). The objective of this study was to evaluate the safety and effectiveness of DAPT compared to using a single antiplatelet therapy (SAPT) as part of the medical armamentarium to treat SCAD.MethodsA comprehensive search of the literature was conducted to identify studies that examined SCAD outcomes including mortality, recurrence, and major adverse cardiovascular events (MACE) between 2000-2023 after antiplatelet therapy was administered. Based on the documentation in various studies, only 17 relevant studies were identified in which SAPT (primarily aspirin) and DAPT (aspirin combined with a P2Y12inhibitor) were administered. Medications used in cardiovascular medicine that did not provide comprehensive data were excluded from the studies.ResultsDAPT treatment was associated with a poorer prognosis than SAPT 12 months after patients presented with SCAD. A key observation was the prevalence of antiplatelet treatment in SCAD patients, with DAPT prescribed for the majority of cases. At the 12-month time point, DAPT demonstrated had a higher rate of mortality (P = 0.0245), MACE (P = 0.0265), and angina admission rate (P = 0.071), as well as a higher rate of recurrent SCAD (P =0.0579) (Fig. 2). An increased incidence of non-fatal myocardial infarction or emergency percutaneous coronary intervention primarily drove these adverse outcomes.ConclusionIn patients treated with antiplatelet therapy, adverse events that include unstable angina, mortality, and repeat revascularization were greater in patients with more aggressive antiplatelet therapy consisting of DAPT compared with these treated with SAPT.