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Prognostic value of myocardial bridging versus non-obstructive CAD: a long-term follow-up study

Zengfa Huang1, Beibei Cao2, Yang Yang3

  • 1Department of Radiology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, 26 Shengli Avenue, Wuhan, 430014, Hubei, China. hzfz88@163.com.

Scientific Reports
|August 2, 2025
PubMed

Insights

Myocardial bridging (MB) does not predict major adverse cardiovascular events (MACE). Non-obstructive coronary artery disease (CAD) burden is the primary risk factor for MACE in patients without obstructive CAD.

Area of Science:

  • Cardiovascular Imaging and Diagnostics
  • Interventional Cardiology
  • Clinical Risk Stratification

Background:

  • Myocardial bridging (MB) is a congenital anomaly where a segment of a coronary artery travels through the heart muscle.
  • The clinical significance of MB, particularly its predictive value for long-term cardiovascular outcomes, remains debated.
  • Non-obstructive coronary artery disease (CAD) burden is increasingly recognized as a risk factor for adverse events.

Purpose of the Study:

  • To investigate whether myocardial bridging (MB) offers predictive value for long-term cardiovascular events beyond its association with non-obstructive coronary artery disease (CAD) burden.
  • To assess the independent contribution of MB and non-obstructive CAD burden to the risk of major adverse cardiovascular events (MACE).

Main Methods:

  • A multicenter study involving 4176 patients with suspected CAD who underwent coronary computed tomography angiography (CTA).
  • Kaplan-Meier analysis and Cox regression models were used to evaluate the association between MB, non-obstructive CAD burden, and MACE over a median follow-up of 6.04 years.
  • Covariates adjusted for included sex, age, smoking, alcohol consumption, hypertension, and diabetes.

Main Results:

  • Myocardial bridging (MB) was present in 44% of patients without CAD and 40.5% with non-obstructive CAD.
  • The annualized MACE rate was similar between patients with and without MB (1.07% vs. 1.13%).
  • Neither MB depth nor length was associated with MACE risk. However, 2-vessel (HR 1.53) and 3-vessel (HR 1.93) non-obstructive CAD significantly predicted MACE after multivariable adjustment.

Conclusions:

  • Non-obstructive coronary artery disease (CAD) burden, rather than the presence of myocardial bridging (MB), is the primary predictor of future major adverse cardiovascular events (MACE) in patients without obstructive CAD.
  • Future research should incorporate quality of life measures and CT-derived fractional flow reserve (CT-FFR) for enhanced risk stratification in MB patients.

Keywords:
Coronary computed tomography angiographyMyocardial bridgingNon-obstructive coronary artery diseasePrognosis

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