The Outcome of Percutaneous Coronary Intervention for Significant Atherosclerotic Lesions in Segment Proximal to Myocardial Bridge at Left Anterior Descending Coronary Artery

Abstract

This study aimed to evaluate the efficacy of percutaneous coronary intervention (PCI) for significant atherosclerosis lesions proximal to myocardial bridge (MB) at left anterior descending coronary artery (LAD).A total of 330 consecutive patients with LAD significant stenosis, diagnosed as acute coronary syndrome (ACS), were included. Based on whether combined with MB, the patients were divided into the MB group (MB, n = 48) and non-MB group (NMB, n = 282). Drug eluting stents (DES) were successfully implanted in the stenostic segments prior to MB. All patients were followed up during the hospital stay, 30 days and 12 months after PCI, to evaluate the major adverse cardiac events (MACEs).There was no difference in the incidence of MACEs between the two groups (6.2% versus 2.1%, P = 0.254) when in the hospital. During the follow-up of 30 days and 12 months after PCI, the rate of MACEs was significantly higher in the MB group than in the NMB group (18.2% versus 6.4% and 43.8% versus 17.0%, respectively, P < 0.001). Stent restenosis occurred in four patients in the MB group; whereas, in five patients in the NMB group, the rate of stent restenosis was higher in the MB group than in the NMB group (8.3% versus 1.8%, P = 0.036). Cox proportional hazards regression analysis revealed that the presence of MB was an independent predictor of MACEs (hazard ratio (HR) = 1.781, 95% confidence intervals (95% CI) = 1.108-2.863, P = 0.017).DES implantation for significant atherosclerosis stenosis in the segments proximal to MB have higher incidence of MACEs. MB appears to be associated with a higher incidence of stent restenosis after PCI and is a significant factor in the occurrence of MACEs.

Post percutaneous coronary interventional outcomes on proximal vs non-proximal lesions of the left and right coronary arteries

“…Other studies have also shown significant lumen obstruction in the segments proximal to myocardial bridge to also have higher chances of re-stenosis and the occurrence of an increased amount of MACEs following PCI with drug eluting stents [15] …”

Retrospective analysis of OCT on MB characteristics and 1-year follow-up of the ISR incidence after the DES implantation in patients with MB

“…Stent into the MB segment could lead to a high rate of coronary artery perforation, stent restenosis, and stent fracture, etc. 25 – 27 . However, there are some conditions where a stent is required to wholly or partially cover the MB.…”

Flow reserve fraction: the optimal choice in lesion assessing and interventional guiding for patient with unstable angina pectoris and intermediate lesion wrapped with myocardial bridge: a case report

“…For such lesion, the most direct way is to implant 2 stents from the normal distal segment to the normal proximal segment of the lesion. However, from the perspective of long-term prognosis, the effect of stents implantation at the myocardial bridge is not good [ 2 ], but if the stents aren’t implanted completely, residual angina attack may still occur. Therefore, the strategy of stent implantation is very important and tricky.…”