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Myocardial Bridging Increases the Risk of Adverse Cardiovascular Events in Patients without Coronary Atherosclerosis
Tsung-Lin Yang1,2,3,4,5, Wen-Rui Hao2,5,6, Chun-Chao Chen2,5,6
1Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
Insights
Myocardial bridging (MB) significantly increases cardiovascular risks in patients with normal coronary vessels. However, this risk is mitigated by atherosclerotic coronary artery disease.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Vascular Biology
Background:
- Myocardial bridging (MB) is a congenital coronary anomaly often linked to chest pain.
- The long-term impact of MB on cardiovascular events requires further investigation.
Purpose of the Study:
- To evaluate the long-term cardiovascular outcomes associated with myocardial bridging.
- To compare the risk of major adverse cardiovascular events in patients with and without MB, considering the presence of coronary artery disease.
Main Methods:
- A retrospective analysis using Taiwan's National Health Insurance Research Database.
- Inclusion of patients who underwent coronary angiography, matched with controls using propensity-score matching.
- Primary endpoint: composite of nonfatal myocardial infarction, nonfatal ischemic stroke, and cardiovascular death.
Main Results:
- In patients without coronary artery disease, MB significantly increased the risk of the composite endpoint (HR: 1.57, 95% CI: 1.44-1.72).
- Increased risks of nonfatal myocardial infarction and cardiovascular death drove the composite endpoint in MB patients with normal coronaries.
- MB did not elevate major adverse cardiovascular events in patients with significant coronary artery disease.
Conclusions:
- Myocardial bridging significantly elevates cardiovascular risk in individuals with healthy coronary arteries.
- The presence of atherosclerotic coronary artery disease diminishes the adverse cardiovascular impact of MB.
- MB can be clinically equated to insignificant coronary artery disease regarding long-term outcomes.
Abstract:
Background: Myocardial bridging (MB) is a congenital coronary anomaly and an important cause of chest pain. The long-term effects of MB on cardiovascular events remain elusive. Methods: We used the National Health Insurance Research Database of Taiwan to conduct an analysis. All patients who had undergone coronary angiography were considered for inclusion. The primary endpoint was a composite of nonfatal myocardial infarction, nonfatal ischemic stroke, and cardiovascular death. Results: We identified 10,749 patients from 2008 to 2018 and matched them with an equal number of controls by propensity-score matching. The mean follow-up period was 5.78 years. In patients without coronary artery disease, MB increased the risk of the composite endpoint (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.44-1.72, p < 0.001), which was driven by increased risks of nonfatal myocardial infarction and cardiovascular death. In patients with significant coronary artery disease, MB did not increase the risk of major adverse cardiovascular events. MB was identical to insignificant coronary artery disease from the viewpoint of clinical outcomes. Conclusions: The presence of MB significantly increases cardiovascular risks in patients with normal coronary vessels. Atherosclerotic coronary artery disease mitigates the effect of MB on cardiovascular outcomes. MB can be considered an insignificant coronary artery disease equivalent.
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