Outcome of intracoronary stenting after failed maximal medical therapy in patients with symptomatic myocardial bridge.
OBJECTIVE
The aim of the present study was to study the outcome of coronary stenting in patients with symptomatic myocardial bridging refractory to standard medical therapy.


BACKGROUND
Medical therapy constitutes the first line treatment for patients with symptomatic myocardial bridge, surgical correction may be offered to select patients with refractory symptoms. Limited data exists on the outcome of coronary stenting in this patient cohort.


METHODS
Twenty-nine patients with symptoms of angina, documented myocardial ischemia and angiographically documented myocardial bridge of the left anterior descending artery (defined as [mt]50% systolic compression) were identified retrospectively. Seventeen (59%) patients responded to maximized medical therapy (mean age 51 +/- 16 years, range 29-80, 7 female) and 12 (41%) patients received coronary stents following a failed attempt of minimum 3 months of maximal medical therapy (mean age 49 +/- 15 years, range 32-76 years, 5 females). Medical therapy responders were compared with intracoronary stent group for recurrent severe angina, target vessel revascularization (TVR), myocardial infarction (MI), and death at follow-up.


RESULTS
Intracoronary stents were placed in all patients successfully. The incidence of recurrent severe angina and TVR were significantly greater in the stent group (P = 0.04) while MI and death in two groups were similar at mean follow-up of 15 +/- 3 months.


CONCLUSIONS
Coronary stent placement for medically refractory symptomatic myocardial bridge failed to relieve severe angina and is associated with high clinical restenosis and hence should be avoided.
Kunamneni
Prabhakar B
PB
Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, New York 10029-6754, USA.
Rajdev
Sanjay
S
Krishnan
Prakash
P
Moreno
Pedro R
PR
Kim
Michael C
MC
Sharma
Samin K
SK
Kini
Annapoorna S
AS
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002932:Cineangiography; D023903:Coronary Restenosis / Q000453:epidemiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054084:Myocardial Bridging / Q000188:drug therapy* / Q000628:therapy*; D019233:Retreatment; D012189:Retrospective Studies; D015607:Stents; D017211:Treatment Failure
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers