Presence and Relevance of Myocardial Bridge in LAD-PCI of CTO and Non-CTO Lesions

Kei Yamamoto, Yoichiro Sugizaki, Dimitri Karmpaliotis, Takao Sato, Mitsuaki Matsumura, Shuro Narui, Myong Hwa Yamamoto, Khady N. Fall, Elizabeth I. James, John B. Glinski, Maya L. Rabban, Megha Prasad, Vivian G. Ng, Sanjum S. Sethi, Tamim M. Nazif, Sahil A. Parikh, Torsten P. Vahl, Ziad A. Ali, Le Roy E. Rabbani, Michael B. CollinsMartin B. Leon, Margaret McEntegart, Jeffrey W. Moses, Ajay J. Kirtane, Masahiko Ochiai, Gary S. Mintz, Akiko Maehara

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Intravascular ultrasound (IVUS) studies show that one-quarter of left anterior descending (LAD) arteries have a myocardial bridge. An MB may be associated with stent failure when the stent extends into the MB. Objectives: The aim of this study was to investigate: 1) the association between an MB and chronic total occlusion (CTO) in any LAD lesions; and 2) the association between an MB and subsequent clinical outcomes after percutaneous coronary intervention in LAD CTOs. Methods: A total of 3,342 LAD lesions with IVUS-guided percutaneous coronary intervention (280 CTO and 3,062 non-CTO lesions) were included. The primary outcome was target lesion failure (cardiac death, target vessel myocardial infarction, definite stent thrombosis, and ischemic-driven target lesion revascularization). Results: An MB by IVUS was significantly more prevalent in LAD CTOs than LAD non-CTOs (40.4% [113/280] vs 25.8% [789/3,062]; P < 0.0001). The discrepancy in CTO length between angiography and IVUS was greater in 113 LAD CTOs with an MB than 167 LAD CTOs without an MB (6.0 [Q1, Q3: 0.1, 12.2] mm vs 0.2 [Q1, Q3: −1.4, 8.4] mm; P < 0.0001). Overall, 48.7% (55/113) of LAD CTOs had a stent that extended into an MB after which target lesion failure was significantly higher compared to a stent that did not extend into an MB (26.3% vs 0%; P = 0.0004) or compared to an LAD CTO without an MB (26.3% vs 9.6%; P = 0.02). Conclusions: An MB was more common in LAD CTO than non-CTO LAD lesions. If present, approximately one-half of LAD CTOs had a stent extending into an MB that, in turn, was associated with worse outcomes.

Original languageEnglish
Pages (from-to)491-501
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume17
Issue number4
DOIs
StatePublished - 26 Feb 2024
Externally publishedYes

Keywords

  • chronic total occlusion
  • left anterior descending artery
  • myocardial bridge
  • percutaneous coronary intervention

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