Abstract Introduction In 2018 the first consensus documents to guide investigation and treatment of spontaneous coronary artery dissection (SCAD) were published. The global quality-of-care of patients with SCAD, as measured by adherence to these recommendations, has not been systematically reviewed. Purpose We aimed to evaluate the quality-of-care, measured by adherence to five recommendations from the 2018 consensus statement [antiplatelets, beta-blockers, angiotensin converting enzyme inhibitors or aldosterone receptor blockers (ACEI/ARBs) in patients with left ventricular systolic dysfunction, screening for fibromuscular dysplasia (FMD) and referral to cardiac rehabilitation] in patients with SCAD. Secondary aims were to explore the relationship of high versus low guideline-recommendation adherence with major adverse cardiovascular events (MACE). Methods Four databases (MEDLINE, EMBASE, SCOPUS, CINAHL) were systematically searched from inception to 16th June 2022. Studies reporting any cohort of 11 or more patients with SCAD that included results of at least one consensus-recommendations were included. The proportion of patients receiving each of the treatments were analysed by random effects meta-analysis. Associations were assessed using meta-regression analysis. Results 54 studies, n=8456 patients (mean age 50.1 years, 89.5% female) were included in the analysis. A random effects meta-analysis found, 94.5% [95% confidence interval (CI): 90.8,97.7)\] received at least one antiplatelet, 78% (CI: 74.2,82.7) received beta-blockers, 54.6% (CI:42.0,66.6) were screened for FMD and 70.5% (CI: 62.6,77.3) were referred to cardiac rehabilitation. 59.3% (CI: 53.1,65.3) received ACEI/ARBs with left ventricular ejection fraction not reported in most studies. A single North American cohort reported 30% of patients met all four recommendations. There was significant heterogeneity in quality-of-care parameters, except for cardiac rehabilitation, according to geographic region (test of heterogeneity, p<0.001). No significant difference was observed in adherence to recommendations in studies published before and after the consensus documents publication (2018), except for lower cardiac rehabilitation referrals after 2018 (test of heterogeneity, p=0.006). There was no association between antiplatelet or beta-blocker use or FMD screening and follow-up MACE. Higher adherence to ACEI/ARBs was associated with lower MACE (p=0.02). Conclusion Adherence to consensus recommendations for care of patients with SCAD is far from perfect and varies significantly between regions of the world. Raising awareness among clinicians about consensus recommendations for care, combined with better evidence on treatment that can reduce MACE in patients with SCAD, are urgently needed.