Key result
Calcium channel blockers maintain 6-month asymptomatic status in a bridging-induced anterior STEMI case.
Why the study?
Although commonly considered benign, myocardial bridging may precipitate acute coronary syndromes.
Case Report (n=1)
This case highlights that myocardial bridging can rarely precipitate acute coronary syndromes such as STEMI, which can be diagnosed using multimodality imaging and successfully managed with conservative medical therapy.
Conservative calcium channel blocker management succeeded post-myocardial bridging STEMI; extends limited RCT evidence on non-invasive options in select cases.
Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of an epicardial artery follows an intramyocardial course. Although commonly considered benign, MB may precipitate acute coronary syndromes (ACS). We describe a 56-year-old man who presented with anterior ST-elevation myocardial infarction (STEMI) in the absence of obstructive coronary artery disease. Urgent coronary angiography demonstrated marked dynamic systolic compression of the mid-left anterior descending (LAD) artery, consistent with MB, without fixed stenosis. Coronary computed tomography angiography confirmed a tunnelled mid-LAD segment without atherosclerotic plaque, and cardiac magnetic resonance imaging revealed subendocardial late gadolinium enhancement in the LAD territory, confirming infarction. Coronary functional testing was deferred in the acute setting; however, the clinical presentation strongly suggested a vasospastic mechanism in the context of myocardial bridging. The patient was managed conservatively with calcium channel blockers and risk factor modification, remaining asymptomatic at 6-month follow-up. This case underscores the value of multimodality imaging in establishing the anatomical and tissue-level correlates of MB-related ACS and highlights that myocardial bridging, though often incidental, can rarely result in clinically significant ischemia and infarction.
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Yar et al. (2026) conducted a case report in Myocardial infarction secondary to myocardial bridging (n=1). Myocardial bridging was evaluated on Symptom status at follow-up. Myocardial bridging resulted in an anterior STEMI in a 56-year-old man, who remained asymptomatic at 6-month follow-up after conservative management with calcium channel blockers.
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