Spontaneous coronary artery dissection (SCAD) presenting with cardiogenic shock (CS) remains insufficiently described. Published in Panminerva Medica, this systematic review compared clinical characteristics and outcomes between SCAD patients with and without CS.

Data from four studies were analyzed following a structured search of PubMed and Embase up to February 1, 2025. Comparative analysis was performed between patients presenting with SCAD complicated by CS and those without CS.

Patients with SCAD and CS were less likely to be female (odds ratio [OR] 0.64; 95% confidence interval [CI], 0.44–0.94) and less likely to have prior myocardial infarction (MI) (OR 0.71; 95% CI, 0.51–0.99). In contrast, higher odds of heart failure (OR 4.79; 95% CI, 3.30) and renal impairment (OR 2.23; 95% CI, 1.43–3.50) were observed compared with those without CS.

The presence of CS was associated with longer hospital stay, with a mean difference of 6.53 days (95% CI, 5.20–7.86). In-hospital outcomes were worse in patients with CS, including higher mortality (OR 39.15; 95% CI, 4.73–324.25), heart failure (OR 5.32; 95% CI, 2.73–10.37), and stroke (OR 4.91; 95% CI, 2.44–9.89).

SCAD complicated by CS was associated with higher in-hospital risk compared with cases without CS.