Spontaneous coronary artery dissection (SCAD) is an emerging cause of acute coronary syndrome (ACS), disproportionately affecting women. Data on the management and outcomes of these patients remain limited, especially regarding the overall risk of major adverse cardiovascular events (MACE) and arrhythmic complications. This study aimed to investigate the incidence and independent predictors of MACE in SCAD patients. In this single-center, prospective observational study, 76 patients with SCAD were enrolled. Clinical follow-up (mean duration: 4.03±3.4 years) was conducted through in-hospital visits and electronic database monitoring. The primary composite endpoint included MACE, defined as cardiovascular (CV) rehospitalization and death, the secondary endpoint included supraventricular and ventricular arrhythmias. All the patients enrolled were characterized by their clinical presentation, underlying risk factors, and triggers for SCAD. Of the 76 patients, 45 (59.2%) received medical therapy alone, 27 (35.5%) underwent percutaneous coronary intervention (PCI), and four (5.2%) had coronary artery bypass grafting (CABG). During the follow-up period, the primary endpoint occurred in 34 patients (44.7%), with CV rehospitalization as the main cause of MACE (31 patients, 40.8%). Coronary revascularization emerged as the only independent predictor of MACE (HR=1.92, 95% CI 1.13-3.21, P=0.035). The secondary endpoint occurred in 13 patients (17.1%). Although SCAD is often considered a rare and relatively benign cause of ACS, our findings reveal a high rate of CV rehospitalization and mortality. Furthermore, mid-term follow-up indicates that SCAD is associated with supraventricular and non-sustained ventricular arrhythmias, with limited impact on prognosis and generally requiring pharmacological optimization.

Whilst aortic stenosis remains the most prevalent valvular abnormality, the management of asymptomatic severe aortic stenosis remains a clinical challenge. Recently, two randomised-controlled trials (RCTs) - EVOLVED (Early Intervention in Patients With Asymptomatic Severe Aortic Stenosis and Myocardial Fibrosis) and Early TAVR (Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis) - have been published, alongside an extended follow-up from the AVATAR (Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis) study. In response, we conducted a systematic review of PubMed, Ovid, and Cochrane databases, identifying RCTs up to October 29, 2024, that compared early intervention with conventional management. Four studies met the inclusion criteria, with a combined total of 1427 patients across the trials. Meta-analysis of the primary endpoints across these studies demonstrated a benefit with early intervention (HR=0.50, 95% CI: 0.35-0.73). However, we did not find mortality and cardiac mortality to show significant reductions (HR=0.68, 95% CI: 0.40-1.18 and HR=0.66, 95% CI: 0.33-1.29, respectively). Crucially, stroke outcomes were improved with early intervention (HR=0.60, 95% CI: 0.38-0.95), as were unplanned hospitalizations (HR=0.40, 95% CI: 0.30-0.53). These findings confirm the safety of early intervention and suggest a reduction in stroke incidence, although no significant benefits were observed in overall or cardiac mortality; results which can help to guide shared decision-making with patients and prevent adverse health outcomes.