Coronary Vasospasm and Cardiovascular Outcomes in Patients with Isolated Myocardial Bridging: A Retrospective Study

Overview

Journal Cardiol J

Specialty Cardiology & Vascular Diseases

Date 2024 Nov 20

PMID 39564957

Authors

Yeon Heo

Seok Oh

Kyung Hoon Cho

Min Chul Kim

Doo Sun Sim

Young Joon Hong

Ju Han Kim

Youngkeun Ahn

Myung Ho Jeong

Affiliations

Soon will be listed here.

Abstract

Background: Mounting evidence suggests an associated between myocardial bridging (MB) and coronary vasospasm (CVS); however, no consensus has been established on whether CVS worsens clinical outcomes in patients with MB. Therefore, this retrospective study aimed to compare the long-term clinical outcomes in patients with MB based on CVS presence.

Methods: This retrospective study enrolled 254 consecutive patients with MB undergoing provocative testing for coronary reactivity between January 1, 2009 and December 30, 2015, and stratified them into 2 groups: (a) group A (with CVS, n = 168); and (b) group B (without CVS, n = 86). The primary endpoints were major adverse cardiovascular events (MACEs), a composite of cardiac death, cardiac arrest, non-fatal myocardial infarction, ischemia-driven revascularization, ischemia-driven coronary angiography, and ischemia-related hospitalization. Diverse Cox models were used to determine whether CVS independently influenced MACE.

Results: The mean age of study participants was 50.8 years, and 60.2% of them were male. The median follow-up period was 8.15 years. The rate of MACE was 35.1% and 26.7% in groups A and B, respectively. Group A had a significantly higher risk of MACE than group B (the reference group) in model 3 (hazard ratio [HR]:1.92; 95% confidence interval [CI]:1.12-3.29) and model 4 (adjusted HR: 1.94; 95% CI: 1.04-3.59).

Conclusions: The presence of CVS adversely affects clinical outcomes in patients with MB. Further prospective clinical studies are required to confirm this association.

References

Kim H, Jo S, Lee M, Seo W, Kim H, Lee K . Nitrates vs. Other Types of Vasodilators and Clinical Outcomes in Patients with Vasospastic Angina: A Propensity Score-Matched Analysis. J Clin Med. 2022; 11(12). PMC: 9225129. DOI: 10.3390/jcm11123250. View

Oh S, Hyun D, Cho S, Hong Y, Kim J, Ahn Y . Case report: A fatal case of myocardial infarction due to myocardial bridge and concomitant vasospasm: the role of stress gated SPECT. Front Cardiovasc Med. 2023; 10:1188095. PMC: 10265674. DOI: 10.3389/fcvm.2023.1188095. View

Nam P, Choi B, Choi S, Byun J, Mashaly A, Park Y . The impact of myocardial bridge on coronary artery spasm and long-term clinical outcomes in patients without significant atherosclerotic stenosis. Atherosclerosis. 2018; 270:8-12. DOI: 10.1016/j.atherosclerosis.2018.01.026. View

Ishii T, Asuwa N, Masuda S, Ishikawa Y, Kiguchi H, Shimada K . Atherosclerosis suppression in the left anterior descending coronary artery by the presence of a myocardial bridge: an ultrastructural study. Mod Pathol. 1991; 4(4):424-31. View

Park T, Park J, Rha S, Seo H, Choi B, Choi S . Impact of Diltiazem Alone versus Diltiazem with Nitrate on Five-Year Clinical Outcomes in Patients with Significant Coronary Artery Spasm. Yonsei Med J. 2016; 58(1):90-98. PMC: 5122658. DOI: 10.3349/ymj.2017.58.1.90. View

Shiode N, Kato M, Teragawa H, Yamada T, Hirao H, Nomura K . Vasomotility and nitric oxide bioactivity of the bridging segments of the left anterior descending coronary artery. Am J Cardiol. 1998; 81(3):341-3. DOI: 10.1016/s0002-9149(97)00912-0. View

Ge J, Jeremias A, Rupp A, Abels M, Baumgart D, Liu F . New signs characteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler. Eur Heart J. 1999; 20(23):1707-16. DOI: 10.1053/euhj.1999.1661. View

Hwang J, Ko S, Roh H, Song M, Shin J, Chee H . Myocardial bridging of the left anterior descending coronary artery: depiction rate and morphologic features by dual-source CT coronary angiography. Korean J Radiol. 2010; 11(5):514-21. PMC: 2930159. DOI: 10.3348/kjr.2010.11.5.514. View

Chen K, Rha S, Li Y, Poddar K, Jin Z, Minami Y . Impact of hypertension on coronary artery spasm as assessed with intracoronary acetylcholine provocation test. J Hum Hypertens. 2009; 24(2):77-85. PMC: 3011093. DOI: 10.1038/jhh.2009.40. View

10.

Corban M, Hung O, Eshtehardi P, Rasoul-Arzrumly E, McDaniel M, Mekonnen G . Myocardial bridging: contemporary understanding of pathophysiology with implications for diagnostic and therapeutic strategies. J Am Coll Cardiol. 2014; 63(22):2346-2355. PMC: 4065198. DOI: 10.1016/j.jacc.2014.01.049. View

11.

Sara J, Corban M, Prasad M, Prasad A, Gulati R, Lerman L . Prevalence of myocardial bridging associated with coronary endothelial dysfunction in patients with chest pain and non-obstructive coronary artery disease. EuroIntervention. 2019; 15(14):1262-1268. DOI: 10.4244/EIJ-D-18-00920. View

12.

Teragawa H, Oshita C, Ueda T . The Myocardial Bridge: Potential Influences on the Coronary Artery Vasculature. Clin Med Insights Cardiol. 2019; 13:1179546819846493. PMC: 6495429. DOI: 10.1177/1179546819846493. View

13.

Montone R, Gurgoglione F, Del Buono M, Rinaldi R, Meucci M, Iannaccone G . Interplay Between Myocardial Bridging and Coronary Spasm in Patients With Myocardial Ischemia and Non-Obstructive Coronary Arteries: Pathogenic and Prognostic Implications. J Am Heart Assoc. 2021; 10(14):e020535. PMC: 8483499. DOI: 10.1161/JAHA.120.020535. View

14.

Maseri A, Beltrame J, Shimokawa H . Role of coronary vasoconstriction in ischemic heart disease and search for novel therapeutic targets. Circ J. 2009; 73(3):394-403. DOI: 10.1253/circj.cj-09-0033. View

15.

Kugiyama K, Yasue H, Okumura K, Ogawa H, Fujimoto K, Nakao K . Nitric oxide activity is deficient in spasm arteries of patients with coronary spastic angina. Circulation. 1996; 94(3):266-71. DOI: 10.1161/01.cir.94.3.266. View

16.

Kim J, Choi B, Rha S . Prognostic impact of nitrate therapy in patients with myocardial bridge and coexisting coronary artery spasm. Heart Vessels. 2022; 38(3):291-299. DOI: 10.1007/s00380-022-02165-1. View

17.

Takahashi J, Nihei T, Takagi Y, Miyata S, Odaka Y, Tsunoda R . Prognostic impact of chronic nitrate therapy in patients with vasospastic angina: multicentre registry study of the Japanese coronary spasm association. Eur Heart J. 2014; 36(4):228-37. DOI: 10.1093/eurheartj/ehu313. View

18.

Hostiuc S, Negoi I, Rusu M, Hostiuc M . Myocardial Bridging: A Meta-Analysis of Prevalence. J Forensic Sci. 2017; 63(4):1176-1185. DOI: 10.1111/1556-4029.13665. View

19.

Kim P, Hur G, Kim S, Namgung J, Hong S, Kim Y . Frequency of myocardial bridges and dynamic compression of epicardial coronary arteries: a comparison between computed tomography and invasive coronary angiography. Circulation. 2009; 119(10):1408-16. DOI: 10.1161/CIRCULATIONAHA.108.788901. View

20.

Choi B, Park S, Rha S, Park J, Choi S, Park Y . Five-year clinical outcomes in patients with significant coronary artery spasm: A propensity score-matched analysis. Int J Cardiol. 2015; 184:533-539. DOI: 10.1016/j.ijcard.2015.02.021. View