Key result
Conservative management with beta-blockers and aspirin resulted in no recurrent myocardial infarction and marked improvement in exertional chest pain at 3-year follow-up.
Why the study?
Myocardial bridging can rarely cause MINOCA and pose diagnostic challenges.
Case Report (n=1)
No
Severe myocardial bridging can cause MINOCA, and multimodal evaluation with resting full-cycle ratio and perfusion imaging can guide successful conservative management with beta-blockers.
May support beta-blocker use in selected myocardial bridging MINOCA; leaves open need for prospective trials before broader adoption.
Background Myocardial bridging (MB) is often considered a benign anatomical variant, yet deep or long bridges can result in dynamic coronary compression and ischemia. In rare instances, MB may lead to myocardial infarction with nonobstructive coronary arteries (MINOCA), posing a diagnostic challenge. Case summary We report the case of a 59-year-old man who presented with chest pain and elevated cardiac troponin following exertion. Coronary angiography showed no obstructive coronary artery disease but revealed a myocardial bridge in the mid-left anterior descending (LAD) artery with complete systolic compression. Intravascular ultrasound (IVUS) confirmed the presence of MB without underlying atherosclerosis. Functional assessment using resting full-cycle ratio (RFR) demonstrated a value of 0.91. Single-photon emission computed tomography (SPECT) revealed no perfusion defects, supporting the absence of significant ischemia. The patient was diagnosed with MINOCA secondary to myocardial bridging and treated conservatively with beta-blockers. He remained free of recurrent myocardial infarction and the exertional chest pain was markedly improved. Discussion This case highlights the potential of severe MB to cause infarction in the absence of fixed coronary lesions. It also underscores the diagnostic utility of RFR in assessing MB physiology and its concordance with perfusion imaging.
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Gao et al. (2026) conducted a case report in MINOCA secondary to myocardial bridging (n=1). Conservative medical therapy (metoprolol and aspirin) was evaluated on Recurrent myocardial infarction and exertional chest pain. Conservative management with beta-blockers and aspirin resulted in no recurrent myocardial infarction and marked improvement in exertional chest pain at 3-year follow-up.
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