Long-term prognosis and outcome in patients with a chest pain syndrome and myocardial bridging

A 64-slice coronary computed tomography angiography study

Ronen Rubinshtein, Tamar Gaspar, Basil S. Lewis, Abhiram Prasad, Nathan Peled, David A. Halon

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

BackgroundSmall case series have associated coronary myocardial bridging (MB) with adverse cardiac events. However, the clinical significance of MB in unselected patients with chest pain remains unclear. The purpose of this study was to explore the relation between the presence of isolated MB and subsequent adverse cardiac events in symptomatic patients referred for coronary computed tomography angiography (CCTA).Methods and resultsThree hundred and thirty-four consecutive patients (age 57 ± 13 years, 43% female) with chest pain and no prior history of coronary artery disease (CAD) who underwent 64-slice CCTA and had no obstructive CAD (≥50% coronary luminal obstruction) were included. Patients were followed for cardiac events [cardiovascular (CV) death or non-fatal myocardial infarction (MI)] over 6.1 ± 1 years. Outcomes were compared between patients with MB vs. those without MB using the Cox models. MB was present in 117 out of 334 (35%) patients on CCTA and 80% of MB involved the mid-distal left anterior descending coronary artery. During a mean follow-up duration of 6.1 ± 1 years, cardiac events occurred in 6 out of 117 (5.1%) patients with, and 7 out of 217 (3.2%) patients without MB (P = 0.40). Univariate predictors of cardiac events were hypertension [hazards ratio (HR) = 10.6, P = 0.002], diabetes mellitus (HR = 4.8, P = 0.01), and older age (HR = 1.1, P = 0.0004). The association of hypertension and age with adverse cardiac events remained statistically significant after adjusting for other variables. Neither the presence nor the extent of MB was associated with an increased risk of cardiac events.ConclusionMB is a common finding on CCTA among patients presenting with chest pain but no obstructive CAD. No association was evident between MB and the risk of CV death or MI. Published on behalf of the European Society of Cardiology. All rights reserved.

Original languageEnglish (US)
Pages (from-to)579-585
Number of pages7
JournalEuropean Heart Journal Cardiovascular Imaging
Volume14
Issue number6
DOIs
StatePublished - Jun 2013

Fingerprint

Myocardial Bridging
Chest Pain
Coronary Artery Disease
Myocardial Infarction
Computed Tomography Angiography
Hypertension
Proportional Hazards Models
Coronary Vessels
Diabetes Mellitus

Keywords

  • Coronary artery disease
  • Coronary computed tomography angiography
  • Myocardial bridging
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Long-term prognosis and outcome in patients with a chest pain syndrome and myocardial bridging : A 64-slice coronary computed tomography angiography study. / Rubinshtein, Ronen; Gaspar, Tamar; Lewis, Basil S.; Prasad, Abhiram; Peled, Nathan; Halon, David A.

In: European Heart Journal Cardiovascular Imaging, Vol. 14, No. 6, 06.2013, p. 579-585.

Research output: Contribution to journalArticle

Rubinshtein, Ronen ; Gaspar, Tamar ; Lewis, Basil S. ; Prasad, Abhiram ; Peled, Nathan ; Halon, David A. / Long-term prognosis and outcome in patients with a chest pain syndrome and myocardial bridging : A 64-slice coronary computed tomography angiography study. In: European Heart Journal Cardiovascular Imaging. 2013 ; Vol. 14, No. 6. pp. 579-585.
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abstract = "BackgroundSmall case series have associated coronary myocardial bridging (MB) with adverse cardiac events. However, the clinical significance of MB in unselected patients with chest pain remains unclear. The purpose of this study was to explore the relation between the presence of isolated MB and subsequent adverse cardiac events in symptomatic patients referred for coronary computed tomography angiography (CCTA).Methods and resultsThree hundred and thirty-four consecutive patients (age 57 ± 13 years, 43{\%} female) with chest pain and no prior history of coronary artery disease (CAD) who underwent 64-slice CCTA and had no obstructive CAD (≥50{\%} coronary luminal obstruction) were included. Patients were followed for cardiac events [cardiovascular (CV) death or non-fatal myocardial infarction (MI)] over 6.1 ± 1 years. Outcomes were compared between patients with MB vs. those without MB using the Cox models. MB was present in 117 out of 334 (35{\%}) patients on CCTA and 80{\%} of MB involved the mid-distal left anterior descending coronary artery. During a mean follow-up duration of 6.1 ± 1 years, cardiac events occurred in 6 out of 117 (5.1{\%}) patients with, and 7 out of 217 (3.2{\%}) patients without MB (P = 0.40). Univariate predictors of cardiac events were hypertension [hazards ratio (HR) = 10.6, P = 0.002], diabetes mellitus (HR = 4.8, P = 0.01), and older age (HR = 1.1, P = 0.0004). The association of hypertension and age with adverse cardiac events remained statistically significant after adjusting for other variables. Neither the presence nor the extent of MB was associated with an increased risk of cardiac events.ConclusionMB is a common finding on CCTA among patients presenting with chest pain but no obstructive CAD. No association was evident between MB and the risk of CV death or MI. Published on behalf of the European Society of Cardiology. All rights reserved.",
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T2 - A 64-slice coronary computed tomography angiography study

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AU - Gaspar, Tamar

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AU - Prasad, Abhiram

AU - Peled, Nathan

AU - Halon, David A.

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N2 - BackgroundSmall case series have associated coronary myocardial bridging (MB) with adverse cardiac events. However, the clinical significance of MB in unselected patients with chest pain remains unclear. The purpose of this study was to explore the relation between the presence of isolated MB and subsequent adverse cardiac events in symptomatic patients referred for coronary computed tomography angiography (CCTA).Methods and resultsThree hundred and thirty-four consecutive patients (age 57 ± 13 years, 43% female) with chest pain and no prior history of coronary artery disease (CAD) who underwent 64-slice CCTA and had no obstructive CAD (≥50% coronary luminal obstruction) were included. Patients were followed for cardiac events [cardiovascular (CV) death or non-fatal myocardial infarction (MI)] over 6.1 ± 1 years. Outcomes were compared between patients with MB vs. those without MB using the Cox models. MB was present in 117 out of 334 (35%) patients on CCTA and 80% of MB involved the mid-distal left anterior descending coronary artery. During a mean follow-up duration of 6.1 ± 1 years, cardiac events occurred in 6 out of 117 (5.1%) patients with, and 7 out of 217 (3.2%) patients without MB (P = 0.40). Univariate predictors of cardiac events were hypertension [hazards ratio (HR) = 10.6, P = 0.002], diabetes mellitus (HR = 4.8, P = 0.01), and older age (HR = 1.1, P = 0.0004). The association of hypertension and age with adverse cardiac events remained statistically significant after adjusting for other variables. Neither the presence nor the extent of MB was associated with an increased risk of cardiac events.ConclusionMB is a common finding on CCTA among patients presenting with chest pain but no obstructive CAD. No association was evident between MB and the risk of CV death or MI. Published on behalf of the European Society of Cardiology. All rights reserved.

AB - BackgroundSmall case series have associated coronary myocardial bridging (MB) with adverse cardiac events. However, the clinical significance of MB in unselected patients with chest pain remains unclear. The purpose of this study was to explore the relation between the presence of isolated MB and subsequent adverse cardiac events in symptomatic patients referred for coronary computed tomography angiography (CCTA).Methods and resultsThree hundred and thirty-four consecutive patients (age 57 ± 13 years, 43% female) with chest pain and no prior history of coronary artery disease (CAD) who underwent 64-slice CCTA and had no obstructive CAD (≥50% coronary luminal obstruction) were included. Patients were followed for cardiac events [cardiovascular (CV) death or non-fatal myocardial infarction (MI)] over 6.1 ± 1 years. Outcomes were compared between patients with MB vs. those without MB using the Cox models. MB was present in 117 out of 334 (35%) patients on CCTA and 80% of MB involved the mid-distal left anterior descending coronary artery. During a mean follow-up duration of 6.1 ± 1 years, cardiac events occurred in 6 out of 117 (5.1%) patients with, and 7 out of 217 (3.2%) patients without MB (P = 0.40). Univariate predictors of cardiac events were hypertension [hazards ratio (HR) = 10.6, P = 0.002], diabetes mellitus (HR = 4.8, P = 0.01), and older age (HR = 1.1, P = 0.0004). The association of hypertension and age with adverse cardiac events remained statistically significant after adjusting for other variables. Neither the presence nor the extent of MB was associated with an increased risk of cardiac events.ConclusionMB is a common finding on CCTA among patients presenting with chest pain but no obstructive CAD. No association was evident between MB and the risk of CV death or MI. Published on behalf of the European Society of Cardiology. All rights reserved.

KW - Coronary artery disease

KW - Coronary computed tomography angiography

KW - Myocardial bridging

KW - Prognosis

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