Interplay Between Myocardial Bridging and Coronary Spasm in Patients With Myocardial Ischemia and Non‐Obstructive Coronary Arteries: Pathogenic and Prognostic Implications

Figure 1. Myocardial bridging and coronary spasm among patients with NOCAD with myocardial ischemia undergoing acetylcholine provocative test. A, Incidence of myocardial bridging, positive acetylcholine provocative test, MINOCA, and stable non‐obstructive coronary artery disease among patients with myocardial ischemia and non‐obstructive coronary artery disease enrolled in our study. B, Incidence of a positive response at acetylcholine test, epicardial spasm or microvascular spasm according to the presence or absence of myocardial bridging. MB+ indicates myocardial bridging presence; MB−, myocardial bridging absence; MINOCA, myocardial infarction and non‐obstructive coronary arteries; and NOCAD, non‐obstructive coronary artery disease.

Figure 2. Survival Kaplan–Meier curves for major adverse cardiac events according to the presence or absence of myocardial bridging (A), and according to the presence/absence of myocardial bridging and positive/negative response at acetylcholine provocative test (B). Ach indicates acetylcholine; MACE, major adverse cardiac events; MB+, myocardial bridging presence; and MB−, myocardial bridging absence.

Figure 3. Curves are compared by the log‐rank test. We had no patient loss at follow‐up. Occurrence of major adverse cardiac events at follow‐up (A) and Seattle Angina Questionnaires summary score at 1‐year (B) according to the presence/absence of myocardial bridging and positive/negative response at acetylcholine provocative test. Ach indicates acetylcholine; MACE, major adverse cardiac events; MB+, myocardial bridging presence; MB−, myocardial bridging absence; and SAQ. Seattle Angina Questionnaires.

Figure 4. Clinical and prognostic implications of the interplay between myocardial bridging and coronary spasm in patients with myocardial ischemia and non‐obstructive coronary artery disease. CAD indicates coronary artery disease; MACE, major adverse cardiac events; and MINOCA, myocardial infarction and non‐obstructive coronary arteries.