| 나승운, Zhe Jin, Kang-Yin Chen, Yoshiyasu Minami, Yong-Jian Li, Kanhaiya L. Poddar, 박재형, 나진오, 최철웅, 임홍의, 김진원, 김응주, 박창규, 서홍석, 오동주 |
Background The association of myocardial bridge (MB) and significant coronary artery spasm (CAS) was reported but whether the detailed angiographic characteristics of MB are associated with significant CAS remains controversial.
Methods Study population consisted of 1,151 patients (pts, age 54.73 ± 11.84 years, male 72%) with suspected angina pectoris, who underwent coronary angiography and Acetylcholine (Ach) provocation test between Nov 2004 and Feb 2007. A total of 323 pts (28%) showed angiographic “milking effect” of MB. The demographic, angiographic parameters and provocation test results of pts with MB (n=323) were compared with those without MB (n=828). Multivariate logistic regression analysis was used to identify the predictors of Ach-induced CAS. In addition, the pts with MB were further divided into two groups according the provocation test results and the characteristics of the MB were compared between the two groups.
Results The percentage of positive provocation test result and of low-dose Ach induced coronary spasm were higher in MB group (71.5% vs. 54.6%, P<0.001 and 10.0% vs. 4.6%, P=0.017, respectively), whereas the fixed lesion in spasm segment was more common in non-MB group (9.5% vs. 3.4%, P<0.001). The multivariate logistic regression analysis revealed that presence of MB and current smoker were independent predictors of Ach-induced significant CAS (MB, OR=3.261, 95% CI 2.069~5.141, P<0.00; current smoker, OR=2.077, 95%CI 1.313~3.287, P=0.002, respectively). In further analysis, the angiographic characteristics of MB such as location, length, and severity of narrowing during systolic period were not different between the provocation test positive and negative group.
Conclusion The presence of MB was an independent predicator of significant CAS and 71.5% of MB pts showed significant Ach induced CAS. However, the angiographic characteristics of MB such as location, length, stenosis during systole and the presence of fixed atherosclerotic lesion within the MB had no impact on the Ach induced CAS.
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