THE STUDY OF INVASIVE CORONARY ANGIOGRAPHIC PROFILE IN PATIENTS WITH ANGINA AND MYOCARDIAL BRIDGING

Abstract

Background: Myocardial bridging (MB) is a congenital coronary artery anomaly in which a segment of an epicardial coronary artery follows an intramyocardial course, resulting in dynamic systolic compression of the tunneled vessel. Although traditionally considered a benign anatomical variant, increasing evidence suggests that hemodynamically significant myocardial bridging may be associated with myocardial ischemia, angina, arrhythmias, and coronary atherosclerosis. Comprehensive evaluation of its clinical profile, angiographic characteristics, and relationship with coronary artery disease remains essential for appropriate diagnosis and management. Aim and Objectives: To determine the prevalence, clinical profile, angiographic characteristics, and hemodynamic significance of myocardial bridging in patients undergoing coronary angiography at a tertiary care centre. Objectives: 1. To study the prevalence and angiographic profile in patients with angina and myocardial bridging. 2. To study its association with atherosclerosis. Materials and Methods: This prospective observational study was conducted in the Department of Cardiology at a tertiary care teaching hospital from January 2024 to June 2026. A total of 335 consecutive adult patients with angiographically confirmed myocardial bridging were included. Demographic characteristics, clinical presentation, cardiovascular risk factors, electrocardiographic and echocardiographic findings, angiographic characteristics, hemodynamic severity, Schwarz classification, and associated coronary artery disease were evaluated. Statistical analysis was performed using SPSS version 27.0, with a p-value <0.05 considered statistically significant. Results: Among 335 patients, the majority belonged to the 50–59-year age group (23.0%), with a slight male predominance (54.6%). Typical angina was present in 50.1% of patients, while 49.9% had atypical chest pain or incidentally detected myocardial bridging. Hypertension (39.7%), dyslipidaemia (35.2%), and diabetes mellitus (33.4%) were the most common cardiovascular risk factors. Normal sinus rhythm was observed in 52.2% of patients, ST–T changes in 35.5%, troponin positivity in 22.7%, and regional wall motion abnormalities in 11.6%. Hemodynamic assessment showed that 80.0% of patients had less than 70% systolic compression, whereas 8.7% demonstrated persistent diastolic compression. Schwarz Type A myocardial bridging was identified in 77.3% of patients. The left anterior descending artery was involved in 99.7% of cases, predominantly affecting the midsegment (77.3%), with a mean bridge length of 20.1 ±6.8 mm. Concomitant coronary artery disease was present in 13.4% of patients, with proximal coronary involvement occurring more frequently than distal disease. Conclusion: Myocardial bridging was predominantly a benign anatomical coronary anomaly characterized by mild-to-moderate hemodynamic involvement and limited association with obstructive coronary artery disease. The left anterior descending artery, particularly its mid-segment, was the principal site of involvement. Comprehensive invasive coronary angiographic evaluation, combined with hemodynamic assessment, is valuable for distinguishing incidental myocardial bridging from clinically significant disease, thereby facilitating accurate risk stratification and appropriate patient management.