Myocardial bridging: therapeutic and clinical development.

BACKGROUND

The myocardial bridge constitutes one of the main differential diagnoses of coronary artery disease. However, it remains an underdiagnosed condition and its physiopathological mechanisms and therapeutics are yet to be elucidated.

OBJECTIVE

To analyze and describe the clinical and therapeutic evolution of patients with an angiographic diagnosis of myocardial bridge, comparing the data with that in the current literature, in order to clarify the patients' clinical profile and prognosis.

METHODS

The results of coronary angiographies carried out from 2003 to 2007 in a Laboratory of Hemodynamics were reviewed; the analysis of patients' files was carried out and selected patients were interviewed.

RESULTS

The frequency of myocardial bridge diagnosis was 3.6%. The mean age of patients was 56.8 years (SD = 11.83; CI = 0.73). The anterior descending artery was affected in isolation in 100% of the cases. After the selection, the analysis and interview of 31 patients were carried out. There was no correlation between symptoms and degree of angiographic narrowing observed in the studied patients. The drug treatment included the use of beta-blockers, calcium-channel antagonists, platelet antiaggregants and/or nitrates and resulted in clinical improvement in 30%, absence of alterations in the clinical picture in 60% and symptom worsening in 10% of the patients. One patient presented sudden death; two patients underwent angioplasty followed by significant clinical improvement and none of the patients underwent surgical procedures.

CONCLUSION

Most of the patients with myocardial bridge have a good prognosis, but in the long term, there are not enough data, obtained from a large sample of symptomatic patients, to draw definitive conclusions.