Purpose: Myocardial Bridging (MB) represents infrequent common coronary anomaly, with few severe adverse events but a relevant symptom burden. Medical therapy, especially with beta-blockers, is the usual first-line treatment in symptomatic patients, with bypass surgery/myotomy or stenting as secondary options, despite absence of randomized trials. Methods: MEDLINE/PubMed was systematically screened for studies reporting on isolated MB 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: 831 patients in 15 studies were included, with a low prevalence of traditional risk factors, especially diabetes [15.6%, InterQuartile Range (IQR) 2.5 – 21.5)]. After a median of 31.0 months (IQR 12.4-37.1), major cardiovascular events (MACEs, composite of death, myocardial infarction, target vessel revascularization [TVR]) occurred with a low rate (3.4%), with 78.7% [70.5-86.9; 95% confidence intervals (CI)] of patients managed conservatively being free of symptoms. When an invasive strategy was planned, freedom from angina was higher in patients treated with surgery [93.6% (91.0-96.3; 95% CI)] than in those treated with stenting [46.3% (28.3-64.4; 95% CI)]. Patients in stenting group experienced a high incidence of MACEs related to TVR [48.7% (30.1-67.3; 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). Conclusions: Patients with symptomatic isolated MB have a good long-term prognosis In the majority of cases. Pharmacological treatment alone, especially with beta-blockers, is able to ameliorate angina in most cases. Surgical treatment appears to be more effective than stenting in non-responders.
What is the optimal treatment for symptomatic patients with isolated coronary myocardial bridge? A systematic review and meta-regression including 831 patients from 15 studies
D'ASCENZO, FABRIZIO;BARBERO, Umberto;GAITA, Fiorenzo
2014-01-01
Abstract
Purpose: Myocardial Bridging (MB) represents infrequent common coronary anomaly, with few severe adverse events but a relevant symptom burden. Medical therapy, especially with beta-blockers, is the usual first-line treatment in symptomatic patients, with bypass surgery/myotomy or stenting as secondary options, despite absence of randomized trials. Methods: MEDLINE/PubMed was systematically screened for studies reporting on isolated MB 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: 831 patients in 15 studies were included, with a low prevalence of traditional risk factors, especially diabetes [15.6%, InterQuartile Range (IQR) 2.5 – 21.5)]. After a median of 31.0 months (IQR 12.4-37.1), major cardiovascular events (MACEs, composite of death, myocardial infarction, target vessel revascularization [TVR]) occurred with a low rate (3.4%), with 78.7% [70.5-86.9; 95% confidence intervals (CI)] of patients managed conservatively being free of symptoms. When an invasive strategy was planned, freedom from angina was higher in patients treated with surgery [93.6% (91.0-96.3; 95% CI)] than in those treated with stenting [46.3% (28.3-64.4; 95% CI)]. Patients in stenting group experienced a high incidence of MACEs related to TVR [48.7% (30.1-67.3; 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). Conclusions: Patients with symptomatic isolated MB have a good long-term prognosis In the majority of cases. Pharmacological treatment alone, especially with beta-blockers, is able to ameliorate angina in most cases. Surgical treatment appears to be more effective than stenting in non-responders.
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