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Published on: January 28, 2020
Coronary vasospasm and cardiovascular outcomes in patients with isolated myocardial bridging: A retrospective study
Yeon Heo1, Seok Oh2, Kyung Hoon Cho2,3
1Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
Insights
Coronary vasospasm (CVS) presence worsens clinical outcomes in patients with myocardial bridging (MB). Patients with MB and CVS experienced significantly higher rates of major adverse cardiovascular events (MACE) over an 8-year follow-up.
Area of Science:
- Cardiology
- Cardiovascular Research
- Clinical Medicine
Background:
- Myocardial bridging (MB) is increasingly associated with coronary vasospasm (CVS).
- The impact of CVS on clinical outcomes in MB patients remains unclear.
- This study investigates the long-term clinical outcomes of MB patients with and without CVS.
Purpose of the Study:
- To compare long-term clinical outcomes in patients with myocardial bridging (MB).
- To determine if coronary vasospasm (CVS) presence influences major adverse cardiovascular events (MACE) in MB patients.
Main Methods:
- Retrospective study of 254 MB patients undergoing provocative testing.
- Stratification into two groups: with CVS (n=168) and without CVS (n=86).
- Primary endpoint: major adverse cardiovascular events (MACE); analyzed using Cox models.
Main Results:
- Median follow-up was 8.15 years.
- MACE rates were 35.1% in the CVS group and 26.7% in the no-CVS group.
- CVS presence independently increased MACE risk (adjusted HR: 1.94; 95% CI: 1.04-3.59).
Conclusions:
- Coronary vasospasm (CVS) adversely impacts clinical outcomes in myocardial bridging (MB) patients.
- The presence of CVS is associated with a higher risk of major adverse cardiovascular events (MACE).
- Further prospective studies are needed to validate these findings.
Background:
Mounting evidence suggests an associated between myocardial bridging (MB) and coronary vasospasm (CVS); however, no consensus has been established on whether CVS worsens clinical outcomes in patients with MB. Therefore, this retrospective study aimed to compare the long-term clinical outcomes in patients with MB based on CVS presence.
Methods:
This retrospective study enrolled 254 consecutive patients with MB undergoing provocative testing for coronary reactivity between January 1, 2009 and December 30, 2015, and stratified them into 2 groups: (a) group A (with CVS, n = 168); and (b) group B (without CVS, n = 86). The primary endpoints were major adverse cardiovascular events (MACEs), a composite of cardiac death, cardiac arrest, non-fatal myocardial infarction, ischemia-driven revascularization, ischemia-driven coronary angiography, and ischemia-related hospitalization. Diverse Cox models were used to determine whether CVS independently influenced MACE.
Results:
The mean age of study participants was 50.8 years, and 60.2% of them were male. The median follow-up period was 8.15 years. The rate of MACE was 35.1% and 26.7% in groups A and B, respectively. Group A had a significantly higher risk of MACE than group B (the reference group) in model 3 (hazard ratio [HR]:1.92; 95% confidence interval [CI]:1.12-3.29) and model 4 (adjusted HR: 1.94; 95% CI: 1.04-3.59).
Conclusions:
The presence of CVS adversely affects clinical outcomes in patients with MB. Further prospective clinical studies are required to confirm this association.
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