Key result
Myocardial bridging was not associated with differences in plaque characteristics compared to no bridging, and atheromatous extension into the bridged segment was seen in 70.5% of bridged cases.
Why the study?
Myocardial bridging is associated with angina, ACS, and sudden cardiac death, with reported proximal vessel atherosclerosis acceleration and bridged segments reported free of disease.
Do plaque characteristics and distribution differ between patients with and without myocardial bridging undergoing IVUS-guided PCI of the LAD?
Observational (n=147)
Do plaque characteristics and distribution differ between patients with and without myocardial bridging undergoing IVUS-guided PCI of the LAD?
Contrary to previous reports, atheromatous involvement extends into bridged segments in patients with myocardial bridging, with no significant differences in overall plaque characteristics compared to those without bridging.
Supports atheromatous extension into bridged segments contrary to prior reports; hypothesis-generating for plaque in myocardial bridging during LAD PCI.
BACKGROUND: Myocardial bridging (MB) is a common congenital cardiovascular anomaly. There are reported associations of MB with different clinical presentations like effort angina, acute coronary syndromes (ACS) and sudden cardiac death. Acceleration of atherosclerosis in proximal vessel is reported in patients with MB, while bridged segments are reported to be free of atherosclerosis. METHODS: We assessed patients who underwent intravascular ultrasound (IVUS) guided percutaneous intervention (PCI) of left anterior descending (LAD) artery. Plaque characteristics derived from IVUS analysis were compared between those who displayed myocardial bridge versus those who did not harbour the anomaly. RESULTS: = .03). 142/147 (96.6%) patients presented with ACS. ST elevation myocardial infarction (STEMI) was the most common presenting diagnosis (110/147 to 74.8%). There were no differences in qualitative plaque characteristics - attenuated plaque, calcification or calcium score between two groups. Plaque burden and length of the lesion in the proximal vessel were not different. Among patients with MB {+}, atheromatous extension to segments underlying the bridge was seen in 31/44 (70.5%) cases. CONCLUSIONS: In a series of patients who presented with advanced clinical atherosclerosis, plaque characteristics were not different in patients who harboured myocardial bridge vs. those who did not have the anomaly. Atheromatous involvement was seen extending into bridged segment contrary to previous reports.
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Narayanan et al. (2023) conducted an observational in Patients undergoing IVUS-guided PCI of the left anterior descending artery (n=147). Myocardial bridge vs. No myocardial bridge was evaluated on Plaque characteristics (attenuated plaque, calcification, calcium score, plaque burden, and lesion length). Myocardial bridging was not associated with differences in plaque characteristics compared to no bridging, and atheromatous extension into the bridged segment was seen in 70.5% of bridged cases.
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