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What is the optimal treatment for symptomatic patients with isolated coronary myocardial bridge? A systematic review and pooled analysis

Cerrato, Enricoa; Barbero, Umbertob; D’Ascenzo, Fabriziob; Taha, Salmab; Biondi-Zoccai, Giuseppec; Omedè, Pierluigib; Bianco, Matteod; Echavarria-Pinto, Mauroe; Escaned, Javierf; Gaita, Fiorenzob; Varbella, Ferdinandoa

Journal of Cardiovascular Medicine: October 2017 - Volume 18 - Issue 10 - p 758–770
doi: 10.2459/JCM.0000000000000551
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Background Myocardial bridging is a common coronary anomaly, with few severe adverse events but a relevant symptom burden. Myocardial bridging treatment, however, remains uncertain because of the lack of randomized trials.

Material MEDLINE/PubMed was systematically screened for studies reporting on isolated myocardial bridging diagnosed at coronary angiography or with coronary computed tomography in patients admitted for suspected angina or with an acute coronary syndrome. Baseline, treatment and outcome data were appraised and pooled according to treatment (medical therapy, bypass surgery/myotomy or stenting).

Results A total of 899 patients in 18 studies were included with a low prevalence of traditional risk factors, especially diabetes (15.6%, interquartile range 2.5–21.5). After a median of 31.0 months (interquartile range 12.4–37.1), major cardiovascular events (composite of death, myocardial infarction or target vessel revascularization) occurred in only 3.4% of the study patients and 78.7% [70.5–86.9; 95% confidence intervals (CI)] were managed conservatively and free of symptoms. When an invasive strategy was planned, freedom from angina was higher in patients treated with surgery [84.5% (78.4–90.7; 95% CI)] than in those treated with stenting [54.7% (38.9–70.6; 95% CI)]. Patients in the stenting group experienced a high incidence of major cardiovascular events related to target vessel revascularization [40.07% (19.83–60.32; 95% CI)]. Meta-regression showed that patients treated with beta-blockers or with a history of hypertension were more likely to remain free from angina (B −0.6, P = 0.013; B −0.66, P = 0.006).

Conclusion Patients with symptomatic isolated myocardial bridging generally have a good long-term prognosis. Pharmacological treatment alone, especially with beta-blockers, is able to improve angina in most cases. Surgical treatment appears to be more effective than stenting in nonresponders.

aInterventional Cardiology, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital

bDivision of Cardiology, Città della Salute e della Scienza, University of Turin, Turin

cDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina and Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli

dDivision of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy

eDepartment of Cardiology, Hospital General ISSSTE, Querétaro, México

fHospital Clinico San Carlos, Madrid, Spain

Correspondence to Dr Enrico Cerrato, Interventional Cardiology, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Regione Gonzole, 10 Turin, Italy E-mail: enrico.cerrato@gmail.com; www.cardiogroup.org

Received 11 February, 2014

Revised 1 July, 2017

Accepted 20 July, 2017

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© 2017 Italian Federation of Cardiology. All rights reserved.