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Comment & Response
June 5, 2019

A Myocardial Bridge or Not?—Reply

Author Affiliations
  • 1Department of Internal Medicine, University of Texas Health Science Center at the Heart and Vascular Institute, Houston
  • 2Division of Cardiovascular Medicine, University of Texas Health Science Center at the Heart and Vascular Institute, Houston
JAMA Cardiol. 2019;4(7):714. doi:10.1001/jamacardio.2019.1664

In Reply We thank Henry et al for their comments about spontaneous coronary artery dissection (SCAD) as an alternative cause of the acute non–ST-elevation myocardial infarction in this patient case.1 Like myocardial bridging (MB), SCAD is usually seen in women presenting with anginal chest pain and no history of heart disease. Furthermore, most patients with SCAD can be treated conservatively, as SCAD can heal spontaneously.2,3 However, angiography findings of significant systole-dependent coronary artery narrowing were more consistent with MB than non–phase-dependent stenosis seen in SCAD. The characteristic type 1 angiographic classification involving arterial wall contrast staining and multiple radiolucent lumens was not appreciated. In less evident cases (types 2 and 3), additional imaging with intravascular ultrasonography or optical coherence tomography can be performed,4 but these modalities were not used at the discretion of the interventional team. Therefore, with our working diagnosis of MB based on clinical picture and angiographic appearance, the coexistence of SCAD cannot be categorically ruled out. We agree that a definitive diagnosis of MB or SCAD may require multimodality imaging.

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