Long-term clinical course of patients with isolated myocardial bridge.
BACKGROUND
Myocardial bridge (MB) is regarded as a common benign lesion on coronary angiography (CAG). It is known to be harmless but may cause several cardiac events and recurrent hospitalization, so in the present study the long-term clinical course of patients with isolated MB and predictors of readmission were investigated.


RESULTS
Total 684 patients (343 males, 60.5+/-11.2 years) with persistent chest pain without critical stenosis on CAG were enrolled. The patients were divided into 2 groups according to the presence of MB. Clinical follow-up was performed with respect to readmission after baseline CAG. At a mean follow-up of 37 months, 92 patients (13.3%) were re-admitted because of 79 recurrent chest pain refractory to medication (11.5%), 8 myocardial infarctions (1.2%), 1 life-threatening arrhythmia (0.1%) and 4 deaths (0.6%). There was a significant higher incidence of readmission in the MB group (P=0.038). In multivariate analysis, long MB (hazard ratio (HR) 2.780; 95% confidence interval (CI) 1.070-7.218, P=0.036) and spontaneous vasospasm in CAG (HR 2.335; 95%CI 1.055-5.171, P=0.037) were the predictors of readmission. Moreover, additional use of aspirin or statin decreased the readmission rate.


CONCLUSIONS
This study suggests that MB on non-occlusive CAG is not benign and may cause recurrent chest pain, myocardial infarction or life-threatening arrhythmia. Especially, patients with a long MB and vasospasm on CAG need intensive medical therapy, including antiplatelet treatment.
Kim
Sung-Soo
SS
Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Jeong
Myung Ho
MH
Kim
Hyun Kuk
HK
Kim
Min Chul
MC
Cho
Kyung Hun
KH
Lee
Min Goo
MG
Ko
Jum Suk
JS
Park
Keun Ho
KH
Sim
Doo Sun
DS
Yoon
Nam Sik
NS
Yoon
Hyun Ju
HJ
Park
Hyung Wook
HW
Kim
Ju Han
JH
Hong
Young Joon
YJ
Ahn
Young Keun
YK
Cho
Jeong Gwan
JG
Park
Jong Chun
JC
Kang
Jung Chaee
JC
D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology; D001241:Aspirin / Q000627:therapeutic use; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D054084:Myocardial Bridging / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D009203:Myocardial Infarction / Q000453:epidemiology*; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin