Efficacy and outcomes of surgical versus interventional treatment of coronary myocardial bridge: a systematic review

Objective To compare the efficacy and outcomes of surgical operations (myotomy and bypass surgery) and coronary stenting for treatment of coronary myocardial bridge. Methods We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure and Wanfang database for studies of treatment of coronary artery myocardial bridge with coronary stenting, myotomy or coronary artery bypass grafting. The data were extracted from the eligible studies, and regression analysis was performed to explore the sources of heterogeneity in the sample size, surgical methods, nations (Asian and others), and year of publication. Results There were 3 584 English articles and 1 678 Chinese articles reviewed in this study, and finially 4 019 articles were recruited after removing duplicate ones. Thirty-three eligible studies involving a total of 1 286 patients were included in the qualitative analysis. A total of 572 patients from 26 studies were included in the quantitative analysis. Analyses of the single rates showed that the overall symptom remission rate of myocardial bridge was 88.00% (95% CI: 81.31%-93.56%) following surgical interventions, which were associated with an overall postoperative coronary artery restenosis rate of 9.09% (95% CI: 4.30%-15.05%) and overall rates of intraoperative complications and postoperative cardiovascular events of 0.59% (95% CI: 0.00%-1.83%) and 0.46% (95% CI: 0.00%-1.63%), respectively. Regression analysis showed that postoperative symptom relief and coronary artery restenosis rates were significantly correlated with the surgical methods used (P < 0.001) but not with the sample size, year of publication, or nationalities of the patients (P > 0.1). Subgroup analysis showed that compared with interventional treatment, surgical treatments resulted in a significantly higher rate of postoperative symptom relief (95.45% vs 68.82%, P < 0.001) and lower rates of coronary artery restenosis (3.89% vs 21.78%, P < 0.001) and postoperative cardiovascular events (0.01% vs 2.91%, P < 0.001). The incidence of intraoperative complications did not differ significantly between surgical and interventional treatments (1.65% vs 0.00%, P=0.1405). Conclusion Surgical treatments result in a higher rate of postoperative symptom relief and a lower postoperative restenosis rate than interventional treatment, but high-quality randomized controlled trials with a large sample size are still needed to verify this conclusion.