Outcomes of coronary artery bypass grafting and different antiplatelet strategies for coronary artery myocardial bridge

The optimal treatment strategy for symptomatic coronary artery myocardial bridge (MB) remains controversial. This study aimed to evaluate the efficacy of coronary artery bypass grafting (CABG) for MB and the influence of different postoperative antiplatelet strategies on graft patency. A total of 95 patients with isolated anterior descending artery MB diagnosed between 2013 and 2023 were retrospectively analysed. Patients were divided into operated ( n = 56) and non-operated groups ( n = 39). The operated group was further stratified by antiplatelet strategy into aspirin monotherapy (ASA, n = 30) and dual antiplatelet therapy (DAPT, n = 24). Kaplan-Meier analysis and Cox proportional hazards regression were used to evaluate graft patency and clinical outcomes. The operated group showed significantly higher symptom improvement rates than the non-operated group (82.1% vs. 48.7%, P = 0.001). Postoperative left ventricular diameter was significantly smaller in the operated group (79 vs. 95 mm, P < 0.001). Multivariate analysis identified DAPT as an independent protective factor against graft restenosis ( P = 0.014, OR = 0.224, 95% CI: 0.068–0.736). Kaplan-Meier analysis demonstrated significantly higher graft patency rates in the DAPT group compared with the ASA group (10-year patency: 79.0% vs. 46.3%, P = 0.026). Symptom improvement was also superior in the DAPT group (100% vs. 70.0%, P = 0.010). CABG is a safe and effective treatment for symptomatic MB. Postoperative DAPT with aspirin plus P2Y12 receptor inhibitors for 24 months was associated with significantly improved long-term graft patency and symptom relief compared with aspirin monotherapy.