Role of myocardial bridgings in acute coronary syndrome genesis in patients under 65 years old


DOI: https://dx.doi.org/10.18565/therapy.2024.4.50-58

Izmozherova N.V., Dmitriev V.K., Bakhtin V.M., Popov A.A.

1) Ural State Medical University of the Ministry of Healthcare of Russia, Yekaterinburg; 2) “New Hospital Medical Association” LLC, Yekaterinburg
Abstract. Myocardial bridging (MB) is a section of muscle tissue lying over a segment of the coronary artery, it is a variant of the coronary anatomy.
The aim: to determine the influence of MM at the clinical manifestations of acute coronary syndrome (ACS) in patients under 65 years of age.
Material and methods. In a case-control study, an analysis of invasive coronary angiography (CAG) was performed on 1469 patients who were treated in “New Hospital Medical Association” LLC in Yekaterinburg from 01/01/19 to 12/31/19. The study included individuals under 65 years of age with ACS manifestations. The main group included 30 patients with systolic coronary artery (CA) compression according to CAG data, and the control group included 30 persons without verified compression of the coronary artery.
Results. Median age of patients in the main group was 58 [46; 62] years, in the control group – 54.5 [48; 60] year. In the main group, 9 patients did not have obstructive lesions of the coronary artery; all patients in the control group had coronary artery stenosis (p = 0.002). In all cases, MB were detected in the middle segment of the anterior interventricular artery (AIA). The frequency of detection of unstable atheroma in the proximal segment of AIA did not differ between patients with and without MB (p = 0.193). The main group (n = 9) differed from the control group (n = 30) by short-term pain syndrome (1.0 vs. 1.6 hours; p = 0.007), higher left ventricular ejection fraction (62.0 vs. 49.0%, respectively; p = 0.007); it did not have a significant increase in troponin T levels (0.0 vs. 1.8 ng/ml, respectively; p < 0.001). In 4 cases, myocardial damage was confirmed by an increase in troponin T levels (maximum value 1.2 ng/ml).
Conclusion. MB can cause manifestations of ACS in patients without obstructive lesions of the coronary artery. In some cases, the effect of MB at coronary blood flow can lead to the formation of myocardial infarction. In ACS patients, the presence of MB is not associated with the formation and destabilization of atheroma in the proximal segment of the coronary artery, and the area of the vessel within MB is not susceptible to the atherosclerotic process.
Keywords: myocardial bridging, coronary angiography, acute coronary syndrome
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About the Autors

Nadezhda V. Izmozherova, MD, Dr. Sci. (Medicine), associate professor, head of the Department of pharmacology and clinical pharmacology, Ural State Medical University of the Ministry of Healthcare of Russia. Address: 620028, Ekaterinburg, 3 Repina St.
E-mail: nadezhda_izm@mail.ru
ORCID: https://orcid.org/0000-0001-7826-9657
Vladimir K. Dmitriev, MD, doctor for X-ray endovascular diagnostics and treatment of “New Hospital Medical Association” LLC. Address: 620109, Ekaterinburg, 29 Zavodskaya St.
E-mail: vkdmitriev@mail.ru
Viktor M. Bakhtin, MD, assistant at the Department of pharmacology and clinical pharmacology, Ural State Medical University of the Ministry of Healthcare of Russia. Address: 620028, Ekaterinburg, 3 Repina St.
E-mail: bakhtin.v95@mail.ru
ORCID: https://orcid.org/0000-0001-7907-2629
Artem A. Popov, MD, Dr. Sci. (Medicine), associate professor, head of the Department of hospital therapy, Ural State Medical University of the Ministry of Healthcare of Russia. Address: 620028, Ekaterinburg, 3 Repina St.
E-mail: art_popov@mail.ru
ORCID: https://orcid.org/0000-0001-6216-2468


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