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Published on: March 27, 2018
Long-term clinical course of patients with isolated myocardial bridge
Sung-Soo Kim1, Myung Ho Jeong, Hyun Kuk Kim
1Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Insights
Myocardial bridges (MB) are not always benign and can lead to recurrent chest pain and heart attacks. Long MB and vasospasm predict readmission, but aspirin and statins may reduce this risk.
Area of Science:
- Cardiology
- Vascular Medicine
- Clinical Research
Background:
- Myocardial bridge (MB) is a common coronary angiography finding, often considered benign.
- However, MB can be associated with cardiac events and hospitalizations.
Purpose of the Study:
- To investigate the long-term clinical course of patients with isolated myocardial bridges.
- To identify predictors of readmission in patients with myocardial bridges.
Main Methods:
- Retrospective analysis of 684 patients with persistent chest pain and non-critical coronary artery stenosis.
- Patients were divided into groups based on the presence of MB.
- Clinical follow-up was conducted for a mean of 37 months to assess readmissions.
Main Results:
- Readmission occurred in 13.3% of patients, primarily due to recurrent chest pain, myocardial infarction, or life-threatening arrhythmia.
- Patients with MB showed a significantly higher incidence of readmission (P=0.038).
- Long MB (HR 2.780) and spontaneous vasospasm (HR 2.335) were identified as independent predictors of readmission.
Conclusions:
- Myocardial bridges on non-occlusive coronary angiography are not benign and can precipitate adverse cardiac events.
- Patients with long MB and vasospasm require intensive medical management.
- Aspirin and statin therapy may decrease readmission rates in these patients.
Background:
Myocardial bridge (MB) is regarded as a common benign lesion on coronary angiography (CAG). It is known to be harmless but may cause several cardiac events and recurrent hospitalization, so in the present study the long-term clinical course of patients with isolated MB and predictors of readmission were investigated.
Methods And Results:
Total 684 patients (343 males, 60.5+/-11.2 years) with persistent chest pain without critical stenosis on CAG were enrolled. The patients were divided into 2 groups according to the presence of MB. Clinical follow-up was performed with respect to readmission after baseline CAG. At a mean follow-up of 37 months, 92 patients (13.3%) were re-admitted because of 79 recurrent chest pain refractory to medication (11.5%), 8 myocardial infarctions (1.2%), 1 life-threatening arrhythmia (0.1%) and 4 deaths (0.6%). There was a significant higher incidence of readmission in the MB group (P=0.038). In multivariate analysis, long MB (hazard ratio (HR) 2.780; 95% confidence interval (CI) 1.070-7.218, P=0.036) and spontaneous vasospasm in CAG (HR 2.335; 95%CI 1.055-5.171, P=0.037) were the predictors of readmission. Moreover, additional use of aspirin or statin decreased the readmission rate.
Conclusions:
This study suggests that MB on non-occlusive CAG is not benign and may cause recurrent chest pain, myocardial infarction or life-threatening arrhythmia. Especially, patients with a long MB and vasospasm on CAG need intensive medical therapy, including antiplatelet treatment.
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