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Coronary Flow in Patients With Myocardial Bridges, Coronary Fistulae in the Setting of Unstable Non-Obstructive

Niya E Semerdzhieva1, Stefan Denchev2

  • 1Emergency, National Heart Hospital, Sofia, BGR.

Cureus
|March 17, 2021
PubMed

Insights

In patients with acute coronary syndrome and non-obstructive coronary disease, epicardial coronary flow improved after glyceryl trinitrate, especially in those with myocardial bridges or coronary fistulae on calcium channel blockers.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Diagnostic Imaging

Background:

  • Acute coronary syndrome (ACS) in patients with non-obstructive coronary disease presents diagnostic challenges.
  • Myocardial bridges and coronary artery fistulae are congenital anomalies that can affect coronary flow.
  • Assessing epicardial coronary flow is crucial for understanding ACS pathophysiology in these patients.

Purpose of the Study:

  • To compare epicardial coronary flow in ACS patients with and without coronary anomalies (myocardial bridges, fistulae) before and after glyceryl trinitrate administration.
  • To evaluate the impact of anti-ischaemic therapy, specifically calcium channel blockers, on coronary flow response.

Main Methods:

  • Coronary angiography was performed on 88 ACS patients with coronary stenoses <50%.
  • Epicardial coronary flow was assessed using the corrected Thrombolysis in Myocardial Infarction frame count (cTFC) method.
  • Measurements were taken at baseline and after intracoronary infusion of 200 µg glyceryl trinitrate.

Main Results:

  • Myocardial bridges and coronary artery fistulae were present in 4.4% and 2.2% of ACS patients, respectively.
  • Sixty-two percent of patients exhibited slow contrast media progression (cTFC>25), indicating impaired coronary flow.
  • Coronary flow improved after glyceryl trinitrate, particularly in patients with myocardial bridges and to a lesser extent in those with fistulae.
  • The response to glyceryl trinitrate was most pronounced in patients on background calcium channel blocker therapy.

Conclusions:

  • Epicardial coronary flow in ACS patients with non-obstructive coronary disease and myocardial bridges shows improved impairment after glyceryl trinitrate.
  • Intracoronary glyceryl trinitrate is effective in improving coronary flow in ACS patients with coronary anomalies on calcium channel blockers.
  • These findings highlight the utility of assessing coronary flow dynamics in managing ACS patients with non-obstructive coronary artery disease and structural variants.

Keywords:
acute coronary syndromecoronary fistulaemyocardial bridgesnon-obstructive coronary diseaseslow coronary flow

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