Long-term prognosis and outcome in patients with a chest pain syndrome and myocardial bridging: a 64-slice coronary computed tomography angiography study.
BACKGROUND
Small case series have associated coronary myocardial bridging (MB) with adverse cardiac events. However, the clinical significance of MB in unselected patients with chest pain remains unclear. The purpose of this study was to explore the relation between the presence of isolated MB and subsequent adverse cardiac events in symptomatic patients referred for coronary computed tomography angiography (CCTA).


RESULTS
Three hundred and thirty-four consecutive patients (age 57 ± 13 years, 43% female) with chest pain and no prior history of coronary artery disease (CAD) who underwent 64-slice CCTA and had no obstructive CAD (≥ 50% coronary luminal obstruction) were included. Patients were followed for cardiac events [cardiovascular (CV) death or non-fatal myocardial infarction (MI)] over 6.1 ± 1 years. Outcomes were compared between patients with MB vs. those without MB using the Cox models. MB was present in 117 out of 334 (35%) patients on CCTA and 80% of MB involved the mid-distal left anterior descending coronary artery. During a mean follow-up duration of 6.1 ± 1 years, cardiac events occurred in 6 out of 117 (5.1%) patients with, and 7 out of 217 (3.2%) patients without MB (P = 0.40). Univariate predictors of cardiac events were hypertension [hazards ratio (HR) = 10.6, P = 0.002], diabetes mellitus (HR = 4.8, P = 0.01), and older age (HR = 1.1, P = 0.0004). The association of hypertension and age with adverse cardiac events remained statistically significant after adjusting for other variables. Neither the presence nor the extent of MB was associated with an increased risk of cardiac events.


CONCLUSIONS
MB is a common finding on CCTA among patients presenting with chest pain but no obstructive CAD. No association was evident between MB and the risk of CV death or MI.
Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center and Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, 7 Michal Street, Haifa, Israel. ronenrub@clalit.org.il
Ronen
R
Rubinshtein
Tamar
T
Gaspar
Basil S
BS
Lewis
Abhiram
A
Prasad
Nathan
N
Peled
David A
DA
Halon
D000328:Adult; D000368:Aged; D002423:Cause of Death; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D061330:Multidetector Computed Tomography / Q000379:methods*; D054084:Myocardial Bridging / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013577:Syndrome; D013997:Time Factors
Coronary artery disease; Coronary computed tomography angiography; Myocardial bridging; Prognosis