What is the optimal treatment for symptomatic patients with isolated coronary myocardial bridge? A systematic review and pooled analysis

Enrico Cerrato, Umberto Barbero, Fabrizio D'Ascenzo, Salma Taha, Giuseppe Biondi-Zoccai, Pierluigi Omedè, Matteo Bianco, Mauro Echavarria-Pinto, Javier Escaned, Fiorenzo Gaita, Ferdinando Varbella

Research output: Contribution to journalReview article

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Abstract

Background Myocardial bridging is a common coronary anomaly, with few severe adverse events but a relevant symptom burden. Myocardial bridging treatment, however, remains uncertain because of the lack of randomized trials. Material MEDLINE/PubMed was systematically screened for studies reporting on isolated myocardial bridging diagnosed at coronary angiography or with coronary computed tomography in patients admitted for suspected angina or with an acute coronary syndrome. Baseline, treatment and outcome data were appraised and pooled according to treatment (medical therapy, bypass surgery/myotomy or stenting). Results A total of 899 patients in 18 studies were included with a low prevalence of traditional risk factors, especially diabetes (15.6%, interquartile range 2.5-21.5). After a median of 31.0 months (interquartile range 12.4-37.1), major cardiovascular events (composite of death, myocardial infarction or target vessel revascularization) occurred in only 3.4% of the study patients and 78.7% [70.5-86.9; 95% confidence intervals (CI)] were managed conservatively and free of symptoms. When an invasive strategy was planned, freedom from angina was higher in patients treated with surgery [84.5% (78.4-90.7; 95% CI)] than in those treated with stenting [54.7% (38.9-70.6; 95% CI)]. Patients in the stenting group experienced a high incidence of major cardiovascular events related to target vessel revascularization [40.07% (19.83-60.32; 95% CI)]. Meta-regression showed that patients treated with beta-blockers or with a history of hypertension were more likely to remain free from angina (B -0.6, P=0.013; B -0.66, P=0.006). Conclusion Patients with symptomatic isolated myocardial bridging generally have a good long-term prognosis. Pharmacological treatment alone, especially with beta-blockers, is able to improve angina in most cases. Surgical treatment appears to be more effective than stenting in nonresponders.

Original languageEnglish
Pages (from-to)758-770
Number of pages13
JournalJournal of Cardiovascular Medicine
Volume18
Issue number10
DOIs
Publication statusPublished - Oct 1 2017

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Myocardial Bridging
Confidence Intervals
Therapeutics
Acute Coronary Syndrome
Coronary Angiography
PubMed
MEDLINE
Myocardial Infarction
Tomography
Pharmacology
Hypertension
Incidence

Keywords

  • congenital anomaly
  • coronary artery bypass graft
  • myocardial bridge
  • myotomy
  • stenting

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

What is the optimal treatment for symptomatic patients with isolated coronary myocardial bridge? A systematic review and pooled analysis. / Cerrato, Enrico; Barbero, Umberto; D'Ascenzo, Fabrizio; Taha, Salma; Biondi-Zoccai, Giuseppe; Omedè, Pierluigi; Bianco, Matteo; Echavarria-Pinto, Mauro; Escaned, Javier; Gaita, Fiorenzo; Varbella, Ferdinando.

In: Journal of Cardiovascular Medicine, Vol. 18, No. 10, 01.10.2017, p. 758-770.

Research output: Contribution to journalReview article

Cerrato, E, Barbero, U, D'Ascenzo, F, Taha, S, Biondi-Zoccai, G, Omedè, P, Bianco, M, Echavarria-Pinto, M, Escaned, J, Gaita, F & Varbella, F 2017, 'What is the optimal treatment for symptomatic patients with isolated coronary myocardial bridge? A systematic review and pooled analysis', Journal of Cardiovascular Medicine, vol. 18, no. 10, pp. 758-770. https://doi.org/10.2459/JCM.0000000000000551
Cerrato, Enrico ; Barbero, Umberto ; D'Ascenzo, Fabrizio ; Taha, Salma ; Biondi-Zoccai, Giuseppe ; Omedè, Pierluigi ; Bianco, Matteo ; Echavarria-Pinto, Mauro ; Escaned, Javier ; Gaita, Fiorenzo ; Varbella, Ferdinando. / What is the optimal treatment for symptomatic patients with isolated coronary myocardial bridge? A systematic review and pooled analysis. In: Journal of Cardiovascular Medicine. 2017 ; Vol. 18, No. 10. pp. 758-770.
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abstract = "Background Myocardial bridging is a common coronary anomaly, with few severe adverse events but a relevant symptom burden. Myocardial bridging treatment, however, remains uncertain because of the lack of randomized trials. Material MEDLINE/PubMed was systematically screened for studies reporting on isolated myocardial bridging diagnosed at coronary angiography or with coronary computed tomography in patients admitted for suspected angina or with an acute coronary syndrome. Baseline, treatment and outcome data were appraised and pooled according to treatment (medical therapy, bypass surgery/myotomy or stenting). Results A total of 899 patients in 18 studies were included with a low prevalence of traditional risk factors, especially diabetes (15.6{\%}, interquartile range 2.5-21.5). After a median of 31.0 months (interquartile range 12.4-37.1), major cardiovascular events (composite of death, myocardial infarction or target vessel revascularization) occurred in only 3.4{\%} of the study patients and 78.7{\%} [70.5-86.9; 95{\%} confidence intervals (CI)] were managed conservatively and free of symptoms. When an invasive strategy was planned, freedom from angina was higher in patients treated with surgery [84.5{\%} (78.4-90.7; 95{\%} CI)] than in those treated with stenting [54.7{\%} (38.9-70.6; 95{\%} CI)]. Patients in the stenting group experienced a high incidence of major cardiovascular events related to target vessel revascularization [40.07{\%} (19.83-60.32; 95{\%} CI)]. Meta-regression showed that patients treated with beta-blockers or with a history of hypertension were more likely to remain free from angina (B -0.6, P=0.013; B -0.66, P=0.006). Conclusion Patients with symptomatic isolated myocardial bridging generally have a good long-term prognosis. Pharmacological treatment alone, especially with beta-blockers, is able to improve angina in most cases. Surgical treatment appears to be more effective than stenting in nonresponders.",
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T1 - What is the optimal treatment for symptomatic patients with isolated coronary myocardial bridge? A systematic review and pooled analysis

AU - Cerrato, Enrico

AU - Barbero, Umberto

AU - D'Ascenzo, Fabrizio

AU - Taha, Salma

AU - Biondi-Zoccai, Giuseppe

AU - Omedè, Pierluigi

AU - Bianco, Matteo

AU - Echavarria-Pinto, Mauro

AU - Escaned, Javier

AU - Gaita, Fiorenzo

AU - Varbella, Ferdinando

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background Myocardial bridging is a common coronary anomaly, with few severe adverse events but a relevant symptom burden. Myocardial bridging treatment, however, remains uncertain because of the lack of randomized trials. Material MEDLINE/PubMed was systematically screened for studies reporting on isolated myocardial bridging diagnosed at coronary angiography or with coronary computed tomography in patients admitted for suspected angina or with an acute coronary syndrome. Baseline, treatment and outcome data were appraised and pooled according to treatment (medical therapy, bypass surgery/myotomy or stenting). Results A total of 899 patients in 18 studies were included with a low prevalence of traditional risk factors, especially diabetes (15.6%, interquartile range 2.5-21.5). After a median of 31.0 months (interquartile range 12.4-37.1), major cardiovascular events (composite of death, myocardial infarction or target vessel revascularization) occurred in only 3.4% of the study patients and 78.7% [70.5-86.9; 95% confidence intervals (CI)] were managed conservatively and free of symptoms. When an invasive strategy was planned, freedom from angina was higher in patients treated with surgery [84.5% (78.4-90.7; 95% CI)] than in those treated with stenting [54.7% (38.9-70.6; 95% CI)]. Patients in the stenting group experienced a high incidence of major cardiovascular events related to target vessel revascularization [40.07% (19.83-60.32; 95% CI)]. Meta-regression showed that patients treated with beta-blockers or with a history of hypertension were more likely to remain free from angina (B -0.6, P=0.013; B -0.66, P=0.006). Conclusion Patients with symptomatic isolated myocardial bridging generally have a good long-term prognosis. Pharmacological treatment alone, especially with beta-blockers, is able to improve angina in most cases. Surgical treatment appears to be more effective than stenting in nonresponders.

AB - Background Myocardial bridging is a common coronary anomaly, with few severe adverse events but a relevant symptom burden. Myocardial bridging treatment, however, remains uncertain because of the lack of randomized trials. Material MEDLINE/PubMed was systematically screened for studies reporting on isolated myocardial bridging diagnosed at coronary angiography or with coronary computed tomography in patients admitted for suspected angina or with an acute coronary syndrome. Baseline, treatment and outcome data were appraised and pooled according to treatment (medical therapy, bypass surgery/myotomy or stenting). Results A total of 899 patients in 18 studies were included with a low prevalence of traditional risk factors, especially diabetes (15.6%, interquartile range 2.5-21.5). After a median of 31.0 months (interquartile range 12.4-37.1), major cardiovascular events (composite of death, myocardial infarction or target vessel revascularization) occurred in only 3.4% of the study patients and 78.7% [70.5-86.9; 95% confidence intervals (CI)] were managed conservatively and free of symptoms. When an invasive strategy was planned, freedom from angina was higher in patients treated with surgery [84.5% (78.4-90.7; 95% CI)] than in those treated with stenting [54.7% (38.9-70.6; 95% CI)]. Patients in the stenting group experienced a high incidence of major cardiovascular events related to target vessel revascularization [40.07% (19.83-60.32; 95% CI)]. Meta-regression showed that patients treated with beta-blockers or with a history of hypertension were more likely to remain free from angina (B -0.6, P=0.013; B -0.66, P=0.006). Conclusion Patients with symptomatic isolated myocardial bridging generally have a good long-term prognosis. Pharmacological treatment alone, especially with beta-blockers, is able to improve angina in most cases. Surgical treatment appears to be more effective than stenting in nonresponders.

KW - congenital anomaly

KW - coronary artery bypass graft

KW - myocardial bridge

KW - myotomy

KW - stenting

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