Symptomatic myocardial bridge: Long-term outcomes and strategies

To analyze clinical outcomes and prognosis under different treatment strategies for myocardial bridging (MB) patients, providing evidence to optimize clinical decision-making.

A retrospective study was conducted on 243 patients diagnosed with MB by coronary angiography at our institution. Of them, 77 patients underwent surgery (group A), and were divided into group A1 (n = 31, compression ≥70%) and group A2 (n = 46, combined with other heart surgeries). The remaining 166 patients underwent medical treatment and were divided into group B1 (n = 125, compression <70%) and group B2 (n = 41, compression ≥70%). The quality of life, mortality, and major adverse cardiac events were analyzed for each group.

Mean follow-up was 55.6 months in Group A and 85.3 months in Group B. The10-year cumulative survival rates for group A1, A2, B1, B2 were 95%, 92.1%, 93.4%, and 88.2%, and the 10-year rates of freedom from major adverse cardiac events in these groups were 89.7%, 85.0%, 74.4%, and 67.8%, respectively. For patients with isolated MB and systolic compression ≥70%, the incidence of major adverse cardiac events was significantly higher than in group B2, compared with group A1 (P = .01). Seattle Angina Questionnaire (SAQ) scores improved significantly after treatment across all groups (P < .01).

For patients with isolated MB and systolic coronary compression ≥70%, and refractory to medical therapy, myotomy had better outcomes than medical therapy. In cases with MB coexisting with other cardiac diseases, myotomy with other cardiac surgeries can achieve satisfactory outcomes. For symptomatic patients with isolated MB and systolic coronary compression <70%, medical treatment can yield good outcomes.