Letter to the Editor in response to ‘Myocardial bridging is significantly associated to myocardial infarction with non-obstructive coronary arteries’ by Matta et al.
Year: 2022
Type: letter
Abstract: In the retrospective study of myocardial bridging (MB) in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA), Matta et al.1 report a low prevalence of angiographic MB that is greater in patients with MINOCA versus myocardial infarction with obstructive coronary artery disease (CAD) (2.9% vs. 0.8%; adjusted odds ratio 3.28, 95% CI: 2.34; 4.61). Unfortunately, the likelihood of reporting MB in routine clinical practice may differ according to the extent of CAD, and if so, differential reporting may bias study findings and expert review of coronary angiography would be necessary to confirm the presence or absence of MB. Matta et al.1 also state that a prospective study from our group leveraging multi-vessel optical coherence tomography (OCT) and cardiac magnetic resonance (CMR) to evaluate mechanisms of MINOCA in women failed to report MB prevalence.2 Indeed, in our cohort of women with MINOCA, the prevalence of MB was quite high at 41%. All MB were identified by OCT in the left anterior descending (LAD) coronary artery.2,3 However, among 46 women with MINOCA and MB, ischaemia or infarction was detected in the LAD territory by CMR imaging in 15 cases (33%); this was not different from the proportion with LAD-territory ischaemic findings in the absence of MB (19/66, 29%, P = 0.82).2 These data raise questions about the role of MB in MINOCA pathogenesis. Since MB are associated with increased odds of coronary spasm by acetylcholine provocation testing,4 MB may serve as a marker of risk rather than a cause of infarction on their own. The work was supported by the American Heart Association via a Strategically Focused Research Networks (SFRN) grant. Conflict of interest: H.R.R. reports non-financial support from Abbott Vascular and Siemens related to the submitted work and non-financial support from BioTelemetry, outside the submitted work. A.M. has received an institutional research grant from and is a consultant for Abbott Vascular and Boston Scientific. N.R.S. served on an advisory board for Abbott Vascular. The remaining authors do not have any disclosures to report. Clinical Trials.gov Identifier: NCT02905357.
Language: English
Topic: Coronary Artery Anomalies
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funder: American Heart Association
OpenAlex ID: W4283328185