040: Myocardial bridging: comparative analysis of coronary angiography and autopsy results

Background Myocardial bridge (MB) is congenital myocardial band overriding a portion of a coronary artery, mainly LAD. Incidence on coronary angiography (CA) appears lesser than on autopsy, which can be ethnics-related, while clinically all forms of coronary artery disease (CAD) are reported: from benign arrhytmias up to sudden death. Aim We sought to determine incidence of MBs in the Serbian population along with respective clinical features. Methods Retrospective analysis was carried out in the same population, during the same 1-year time-frame and comprised consecutive: (A) 721 autopsies, with LM studies of the tunneled vessel (TV) wall together with the morphometric analysis of the ventricular myocardium supplied by TV (experimental group) and the ventricular myocardium of the same heart but with a different blood supply (control group); (B) 4510 CA of symptomatic patients were re-assessed for presence of MBs. Results (A) MBs were described in 6 cases (0.8%): 5 male, all over 70yrs. Only single MB over LAD were found, while all showed: a) TV’ intensive atherosclerotic changes proximal to MB, only focal in the tunneled part; b) intensive interstitial fibroses of the TV-supplied myocardium. (B) MBs were found in 42pts (0.93%): 33 male, aged of 55+11yrs, with single MB over the mid-LAD. 29% were CAD-free, 43% had 1-vessel CAD, 2-v-CAD (24%) and 3-v-CAD (4%). MBs were most frequent in hearts with right coronary dominance (69%). Hypertension and smoking were equally present (69%), dyslipidemia (59%), family history of CAD (48%) and diabetes (21%). Pts presented with stable angina (40%), nonspecific symptoms (14%), unstable angina (7%) and supraventricular arrhythmia (5%), with a history of an anterior wall STEMI vs . NSTEMI in 26% vs . 7%. Conclusions This first overview of MBs-incidence in Serbia (0.8% on autopsy vs . 0.9% on CA) might underestimate its actual presence, which prompted us to continue prospectively.