Anatomic properties of myocardial bridge predisposing to myocardial infarction.
BACKGROUND
A myocardial bridge (MB) that partially covers the course of the left anterior descending coronary artery (LAD) sometimes causes myocardial ischemia, primarily because of hemodynamic deterioration, but without atherosclerosis. However, the mechanism of occurrence of myocardial infarction (MI) as a result of an MB in patients with spontaneously developing atherosclerosis is unclear.


RESULTS
One hundred consecutive autopsied MI hearts either with MBs [MI(+)MB(+) group; n=46] or without MBs (n=54) were obtained, as were 200 normal hearts, 100 with MBs [MI(-)MB(+) group] and 100 without MBs. By microscopy on LADs that were consecutively cross-sectioned at 5-mm intervals, the extent and distribution of LAD atherosclerosis were investigated histomorphometrically in conjunction with the anatomic properties of the MB, such as its thickness, length, and location and the MB muscle index (MB thickness multiplied by MB length), according to MI and MB status. In the MI(+)MB(+) group, the MB showed a significantly greater thickness and greater MB muscle index (P<0.05) than in the MI(-)MB(+) group. The intima-media ratio (intimal area/medial area) within 1.0 cm of the left coronary ostium was also greater (P<0.05) in the MI(+)MB(+) group than in the other groups. In addition, in the MI(+)MB(+) group, the location of the segment that exhibited the greatest intima-media ratio in the LAD proximal to the MB correlated significantly (P<0.001) with the location of the MB entrance, and furthermore, atherosclerosis progression in the LAD proximal to the MB was largest at 2.0 cm from the MB entrance.


CONCLUSIONS
In the proximal LAD with an MB, MB muscle index is associated with a shift of coronary disease more proximally, an effect that may increase the risk of MI.
Ishikawa
Yukio
Y
Department of Pathology, Toho University School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143-8540, Japan. yukio@med.toho-u.ac.jp
Akasaka
Yoshikiyo
Y
Suzuki
Koyu
K
Fujiwara
Mieko
M
Ogawa
Takafumi
T
Yamazaki
Kazuto
K
Niino
Hitoshi
H
Tanaka
Michio
M
Ogata
Kentaro
K
Morinaga
Shojiroh
S
Ebihara
Yoshiro
Y
Kawahara
Yutaka
Y
Sugiura
Hitoshi
H
Takimoto
Toshiro
T
Komatsu
Akio
A
Shinagawa
Toshihito
T
Taki
Kazuhiro
K
Satoh
Hideaki
H
Yamada
Kazuaki
K
Yanagida-Iida
Maki
M
Shimokawa
Reiko
R
Shimada
Kazuyuki
K
Nishimura
Chiaki
C
Ito
Kinji
K
Ishii
Toshiharu
T
D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054084:Myocardial Bridging / Q000453:epidemiology / Q000473:pathology*; D009203:Myocardial Infarction / Q000453:epidemiology / Q000473:pathology*; D012307:Risk Factors; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology