Key result
Myocardial bridging frequently drives MINOCA, requiring intracoronary imaging and functional testing to guide tailored therapy.
Why the study?
MB is emerging as a cause of MINOCA, and identifying the exact underlying pathogenetic mechanism is crucial to establish patient-tailored therapy.
Accurate intracoronary diagnosis of the specific mechanism underlying MINOCA in patients with myocardial bridging is essential to provide individualized, pathophysiology-driven treatment.
May support mechanism-specific evaluation in myocardial bridging-related MINOCA; leaves open optimal testing strategies and outcomes without prospective validation.
Myocardial bridging (MB) is the most frequent congenital coronary anomaly characterized by a segment of an epicardial coronary artery that passes through the myocardium. MB is an important cause of myocardial ischemia and is also emerging as a possible cause of myocardial infarction with non-obstructed coronary arteries (MINOCA). There are multiple mechanisms underlying MINOCA in patients with MB (i.e., MB-mediated increased risk of epicardial or microvascular coronary spasm, atherosclerotic plaque disruption and spontaneous coronary artery dissection). The identification of the exact pathogenetic mechanism is crucial in order to establish a patient-tailored therapy. This review provides the most up-to-date evidence regarding the pathophysiology of MINOCA in patients with MB. Moreover, it focuses on the available diagnostic tools that could be implemented at the time of coronary angiography to achieve a pathophysiologic diagnosis. Finally, it focuses on the therapeutic implications associated with the different pathogenetic mechanisms of MINOCA in patients with MB.
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Rinaldi et al. (2023) conducted a review in Myocardial infarction with non-obstructed coronary arteries (MINOCA) associated with myocardial bridging (MB). Myocardial bridging was evaluated. Myocardial bridging is a frequent cause of MINOCA involving multiple pathogenetic mechanisms, highlighting the need for intracoronary imaging and provocative testing to guide tailored therapy.
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