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Published on: September 15, 2023
Impact of Myocardial Bridges on Long-Term Outcomes After Left Anterior Descending Chronic Total Occlusion
Yingyang Geng1, Tongqiang Zou2, Changdong Guan2
1Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Laboratory of Cardiovascular Disease, Beijing, China.
Background:
A myocardial bridge (MB) is frequently observed after recanalization of a left anterior descending coronary artery (LAD) chronic total occlusion (CTO); however, the long-term prognostic impact of MBs in this specific setting remains controversial.
Objectives:
The aim of this study was to determine the impact of MBs on long-term outcomes in patients undergoing percutaneous coronary intervention of LAD CTOs.
Methods:
Consecutive patients with LAD CTOs who underwent intravascular ultrasound-guided percutaneous coronary intervention from January 2019 to December 2021 were retrospectively analyzed. The primary endpoint was the 5-year rate of major adverse cardiac events (MACE), a composite of cardiac death, spontaneous myocardial infarction, and ischemia-driven revascularization.
Results:
Among 685 patients analyzed, MBs were identified in 393 (57.4%) on intravascular ultrasound; stent extension into the bridged segment occurred in 44.3% of these cases (174 of 393). After a median 5-year follow-up, patients with MBs had a higher incidence of MACE compared with those without MBs (16.1% vs 8.9%; P = 0.006), driven primarily by more ischemia-driven revascularization in the MB group (15.1% vs 7.9%; P = 0.004). Stent extension into the MB was associated with a higher rate of MACE compared with sparing the MB (21.4% vs 11.9%; P = 0.0017). MACE rates did not differ between patients with MBs spared from stenting and those without MBs (11.9% vs 8.9%; P = 0.25).
Conclusions:
MBs are prevalent after LAD CTO recanalization. Although their presence is associated with adverse outcomes, the risk is driven mainly by stent extension into the bridged segment.
