Myocardial bridges are prevalent after LAD CTO recanalization and their presence is associated with adverse outcomes, but the risk is driven mainly by stent extension into the bridged segment.
Myocardial bridges were identified in 57.4% of patients after LAD CTO recanalization using intravascular ultrasound.
Stent extension into the bridged segment occurred in 44.3% of patients who had a myocardial bridge.
Patients with myocardial bridges had a higher 5-year incidence of major adverse cardiac events compared to those without myocardial bridges.
Stent extension into the myocardial bridge was associated with a significantly higher rate of MACE compared with sparing the bridged segment.
MACE rates did not significantly differ between patients with myocardial bridges spared from stenting and those without myocardial bridges.
Ischemia-driven revascularization was the primary driver of the increased MACE observed in patients with myocardial bridges.
This research suggests that a condition called a myocardial bridge — where a segment of a coronary artery runs through heart muscle instead of along its surface — is very common in patients who have had a blocked left heart artery (called a chronic total occlusion) opened up with a stent procedure. More than half of the 685 patients studied (57.4%) were found to have a myocardial bridge after their artery was reopened, which was detected using a specialized imaging tool inserted into the artery called intravascular ultrasound. The study followed patients for a median of five years and tracked serious heart-related events including cardiac death, heart attacks, and the need for additional procedures to restore blood flow. The key finding is that having a myocardial bridge was associated with worse long-term outcomes overall, but the increased risk was almost entirely explained by whether or not the stent was placed into the bridged segment of the artery. When stents were extended into the myocardial bridge (which happened in about 44% of bridge cases), the rate of serious cardiac events was 21.4% — much higher than the 11.9% seen when the bridged segment was deliberately avoided. Importantly, patients whose bridged segment was spared from stenting had outcomes similar to patients who had no myocardial bridge at all (11.9% vs 8.9%, not statistically different). This research suggests that identifying myocardial bridges with intravascular ultrasound before placing stents and then carefully avoiding extending the stent into the bridged tissue may be an important strategy to improve long-term outcomes in patients undergoing this type of procedure. The findings highlight that the myocardial bridge itself may not be inherently dangerous in this setting, but that placing a stent within it appears to drive the increased risk of needing repeat procedures or other heart events over time.
Geng Y, Zou T, Guan C, Zhang Y, Xu J, Liu H, et al.. (2026). Impact of Myocardial Bridges on Long-Term Outcomes After Left Anterior Descending Chronic Total Occlusion Recanalization.. JACC. Cardiovascular interventions. https://doi.org/10.1016/j.jcin.2026.06.020