Yang Tsung-Lin, Hao Wen-Rui, Chen Chun-Chao, Fang Yu-Ann, Leu Hsin-Bang, Liu Ju-Chi, Lin Shing-Jong, Horng Jiun-Lin, Shih Chun-Ming
Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
Life (Basel). 2024 Jun 26;14(7):811. doi: 10.3390/life14070811.
Myocardial bridging (MB) is a congenital coronary anomaly and an important cause of chest pain. The long-term effects of MB on cardiovascular events remain elusive. We used the National Health Insurance Research Database of Taiwan to conduct an analysis. All patients who had undergone coronary angiography were considered for inclusion. The primary endpoint was a composite of nonfatal myocardial infarction, nonfatal ischemic stroke, and cardiovascular death. We identified 10,749 patients from 2008 to 2018 and matched them with an equal number of controls by propensity-score matching. The mean follow-up period was 5.78 years. In patients without coronary artery disease, MB increased the risk of the composite endpoint (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.44-1.72, < 0.001), which was driven by increased risks of nonfatal myocardial infarction and cardiovascular death. In patients with significant coronary artery disease, MB did not increase the risk of major adverse cardiovascular events. MB was identical to insignificant coronary artery disease from the viewpoint of clinical outcomes. The presence of MB significantly increases cardiovascular risks in patients with normal coronary vessels. Atherosclerotic coronary artery disease mitigates the effect of MB on cardiovascular outcomes. MB can be considered an insignificant coronary artery disease equivalent.
心肌桥（MB）是一种先天性冠状动脉异常，也是胸痛的重要原因。MB对心血管事件的长期影响仍不明确。我们利用台湾地区国民健康保险研究数据库进行了一项分析。所有接受冠状动脉造影的患者均被纳入研究。主要终点是由非致命性心肌梗死、非致命性缺血性中风和心血管死亡组成的复合终点。我们从2008年至2018年共识别出10749例患者，并通过倾向得分匹配将他们与同等数量的对照组进行匹配。平均随访期为5.78年。在无冠状动脉疾病的患者中，MB增加了复合终点事件的风险（风险比[HR]：1.57，95%置信区间[CI]：1.44 - 1.72，P < 0.001），这是由非致命性心肌梗死和心血管死亡风险增加所致。在有显著冠状动脉疾病的患者中，MB并未增加主要不良心血管事件的风险。从临床结局的角度来看，MB与非显著冠状动脉疾病相同。MB的存在显著增加了冠状动脉正常患者的心血管风险。动脉粥样硬化性冠状动脉疾病减轻了MB对心血管结局的影响。MB可被视为等同于非显著冠状动脉疾病。
