{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T16:26:50Z","timestamp":1771259210788,"version":"3.50.1"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2017,4,28]],"date-time":"2017-04-28T00:00:00Z","timestamp":1493337600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["European Heart Journal: Acute Cardiovascular Care"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec><jats:title>Introduction:<\/jats:title><jats:p> Patients presenting with spontaneous coronary artery dissection (SCAD) may receive either conservative medical management or a revascularisation strategy. There is still a lack of consensus with respect to the best treatment approach for SCAD. <\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives:<\/jats:title><jats:p> We sought to determine whether outcomes differ between the first-line treatment approaches (conservative versus revascularisation) in patients with SCAD. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p> We searched Medline, EMBASE and the Cochrane Library for studies published from January 1990 to November 2016 that compared first-line treatments for patients with SCAD. We conducted a pooled risk ratio meta-analysis for four main outcomes: mortality, myocardial infarction (MI), SCAD recurrence and target vessel revascularisation (TVR). <\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p> We identified 11 non-randomised studies that included a total of 631 patients. A pooled meta-analysis showed no significant difference between conservative management and revascularisation approaches in mortality (risk difference [RD] = 0.01; 95% confidence interval [CI] = \u22120.01 to 0.04; I<jats:sup>2<\/jats:sup> = 0%; p = 1), MI (RD = \u22120.01; 95% CI = \u22120.04 to 0.03; I<jats:sup>2<\/jats:sup> = 0%; p = 0.5) or SCAD recurrence (RD = \u22120.01; 95% CI = \u22120.06 to 0.05; I<jats:sup>2<\/jats:sup> = 0%; p = 0.74). Revascularisation as an initial first-line approach was associated with an estimated additional risk of TVR of 6.3% (RD = 0.06; 95% CI = 0.01\u22120.11; I<jats:sup>2<\/jats:sup> = 0%; p = 0.96). <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion:<\/jats:title><jats:p> The results demonstrate an increased risk of TVR when revascularisation was used as the initial first-line treatment approach. The treatment decision must be individualised and be based on both clinical and angiographic factors, but conservative therapy should prevail in most cases. <\/jats:p><\/jats:sec>","DOI":"10.1177\/2048872617706502","type":"journal-article","created":{"date-parts":[[2017,4,28]],"date-time":"2017-04-28T09:45:24Z","timestamp":1493372724000},"page":"614-623","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":28,"title":["Medical treatment or revascularisation as the best approach for spontaneous coronary artery dissection: A systematic review and meta-analysis"],"prefix":"10.1093","volume":"7","author":[{"given":"Jos\u00e9 Lu\u00eds","family":"Martins","sequence":"first","affiliation":[{"name":"Department of Cardiology, Baixo Vouga Hospital Centre, Portugal"}]},{"given":"Vera","family":"Afreixo","sequence":"additional","affiliation":[{"name":"CIDMA\/IBIMED\/Department of Mathematics, University of Aveiro, Portugal"}]},{"given":"Lu\u00eds","family":"Santos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Baixo Vouga Hospital Centre, Portugal"}]},{"given":"Marco","family":"Costa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Coimbra Hospital and Universitary Centre \u2013 General Unit, Portugal"}]},{"given":"Jos\u00e9","family":"Santos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Baixo Vouga Hospital Centre, Portugal"}]},{"given":"Lino","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Coimbra Hospital and Universitary Centre \u2013 General Unit, Portugal"}]}],"member":"286","published-online":{"date-parts":[[2017,4,28]]},"reference":[{"key":"bibr1-2048872617706502","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.ejcts.2008.10.023","volume":"35","author":"Vanzetto G","year":"2009","journal-title":"Eur J Cardiothorac 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