Myocardial bridging is significantly associated to myocardial infarction with non-obstructive coronary arteries

Abstract

Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a common disorder characterized by the presence of clinical criteria for acute myocardial infarction in the absence of obstructive coronary artery disease on angiography. We aim to investigate the relationship between myocardial bridging (MB) and MINOCA. Methods and results An observational retrospective study was conducted on 15 036 patients who had been referred for coronary angiography and who fulfilled the Fourth Universal Definition of Myocardial Infarction. The study population was divided into ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients, from which we defined two main groups: the MINOCA group and the coronary artery disease (CAD) group. Statistical analyses were carried out by using SPSS, version 20. The prevalence of angiographic MB among the groups was significantly greater in the MINOCA group (2.9% vs. 0.8%). MINOCA accounted for 14.5% of spontaneous myocardial infarction, and the clinical presentation was more frequently NSTEMI rather than STEMI (84.3% vs. 15.7%). After adjusting for confounders, multivariate analyses showed a positive association between MB and MINOCA [odds ratio = 3.28, 95% CI (2.34; 4.61) P < 0.001]. Cardiovascular risk factors were less common in the MINOCA population, which was younger and more often female. Conclusion MB is a risk factor for MINOCA. Because MB prevalence differed significantly between the controls (CAD group) and cases (MINOCA group), which were positively associated to MB, it seems likely that MB would be a potential cause of MINOCA. Investigations for MB in MINOCA cases and especially in NSTEMI patients seem necessary.

Case report: A fatal case of myocardial infarction due to myocardial bridge and concomitant vasospasm: the role of stress gated SPECT

“…Since most patients with MBs have no clinical symptoms, many clinicians are reluctant to manage it with intensive medical treatments then just tend to recommend simple observation with not much clinical significance. Although most cases with MBs are clinically benign ( 7 ), as suggested in the present case, sometimes it can be one of potential threats of MI and life-threatening arrhythmia ( 9 , 10 ). According to an observational retrospective study, MB seems to be a potential cause of MI, and its prevalence was significantly higher in patients with MINOCA than in their counterparts ( 10 ).…”

“…Although most cases with MBs are clinically benign ( 7 ), as suggested in the present case, sometimes it can be one of potential threats of MI and life-threatening arrhythmia ( 9 , 10 ). According to an observational retrospective study, MB seems to be a potential cause of MI, and its prevalence was significantly higher in patients with MINOCA than in their counterparts ( 10 ). Moreover, since MB itself is one of independent risk factors for ischemia-induced myocardial fibrosis and MINOCA ( 11 ), it also act as a crucial factor contributing to the onset of fatal arrhythmia ( 12 ).…”

Coronary functional assessment in non-obstructive coronary artery disease: Present situation and future direction

“…Recently, myocardial bridging, a congenital coronary anomaly, has also been investigated and is emerging as an important player in determining MINOCA (43). In patients with MINOCA, myocardial bridging is an independent predictor of positive acetylcholine (Ach) test and the coexistence of myocardial bridging and a positive Ach test in frequent, indicating a role for coronary spasm superimposed to myocardial bridging in MINOCA patients (44).…”

MINOCA: One Size Fits All? Probably Not—A Review of Etiology, Investigation, and Treatment

“…Of interest, myocardial bridging, per se, is unlikely to cause MINOCA [ 54 ]. However, it can predispose the affected artery to spasm [ 55 , 56 ].…”