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The impact of myocardial bridge on coronary artery spasm and long-term clinical outcomes in patients without significant atherosclerotic stenosis.
- Source :
-
Atherosclerosis [Atherosclerosis] 2018 Mar; Vol. 270, pp. 8-12. Date of Electronic Publication: 2018 Feb 04. - Publication Year :
- 2018
-
Abstract
- Background and Aims: Myocardial bridge (MB) and coronary artery spasm (CAS) can induce a sustained chest pain, acute coronary syndrome (ACS) and even sudden cardiac death. The aim of this study is to evaluate the relationship between MB and CAS and its impact on long-term clinical outcomes.<br />Methods: A total of 812 patients with MB without significant coronary artery disease (CAD), who underwent acetylcholine (ACH) provocation test, were enrolled. Significant CAS was defined as ≥70% temporary narrowing by ACH test, and MB was defined as the characteristic phasic systolic compression of the coronary artery with a decrease of more than 30% in diameter on the angiogram after intracoronary nitroglycerin infusion. To adjust baseline confounders, logistic regression analysis was performed. The primary endpoint was incidence of CAS, and secondary endpoints were major adverse cardiac events (MACE) and recurrent angina requiring repeat coronary angiography (CAG) at 5 years.<br />Results: MB is closely implicated in a high incidence of CAS, spontaneous spasm, ischemic ECG change and chest pain during ACH provocation test. In addition, MB of various severity and reference vessel size was substantially implicated in CAS incidence, and severe MB was a strong risk factor of CAS. MB patients with CAS were shown to have a higher rate of recurrent angina compared with MB patients without CAS, up to a 5-year follow-up. However, there were no differences regarding the incidence of MACE.<br />Conclusions: Severe MB was associated with high incidence of CAS, and MB patients with CAS were likely to have a higher incidence of recurrent angina. Intensive medical therapy and close clinical follow-up are needed for better clinical outcomes in MB patients with CAS.<br /> (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Subjects :
- Acetylcholine administration & dosage
Adult
Aged
Angina Pectoris epidemiology
Angina Pectoris physiopathology
Coronary Angiography
Coronary Vasospasm diagnostic imaging
Coronary Vasospasm epidemiology
Coronary Vasospasm therapy
Coronary Vessels diagnostic imaging
Female
Humans
Incidence
Male
Middle Aged
Myocardial Bridging diagnostic imaging
Myocardial Bridging epidemiology
Myocardial Bridging therapy
Prognosis
Recurrence
Registries
Retrospective Studies
Risk Factors
Seoul epidemiology
Severity of Illness Index
Time Factors
Vasoconstrictor Agents administration & dosage
Coronary Vasospasm physiopathology
Coronary Vessels physiopathology
Myocardial Bridging physiopathology
Vasoconstriction
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1484
- Volume :
- 270
- Database :
- MEDLINE
- Journal :
- Atherosclerosis
- Publication Type :
- Academic Journal
- Accession number :
- 29407892
- Full Text :
- https://doi.org/10.1016/j.atherosclerosis.2018.01.026