{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T00:04:30Z","timestamp":1793059470053,"version":"4.5.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,7,20]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Myocardial bridging (MB) may represent a cause of myocardial ischemia in patients with non\u2010obstructive coronary artery disease (NOCAD). Herein, we assessed the interplay between MB and coronary vasomotor disorders, also evaluating their prognostic relevance in patients with myocardial infarction and non\u2010obstructive coronary arteries (MINOCA) or stable NOCAD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We prospectively enrolled patients with NOCAD undergoing intracoronary acetylcholine provocative test. The incidence of major adverse cardiac events, defined as the composite of cardiac death, non\u2010fatal myocardial infarction, and rehospitalization for unstable angina, was assessed at follow\u2010up. We also assessed angina status using Seattle Angina Questionnaires summary score. We enrolled 310 patients (mean age, 60.6\u00b111.9; 136 [43.9%] men; 169 [54.5%] stable NOCAD and 141 [45.5%] MINOCA). MB was found in 53 (17.1%) patients. MB and a positive acetylcholine test coexisted more frequently in patients with MINOCA versus stable NOCAD. MB was an independent predictor of positive acetylcholine test and MINOCA. At follow\u2010up (median, 22\u00a0months; interquartile range, 13\u201332), patients with MB had a higher rate of major adverse cardiac events, mainly driven by a higher rate of hospitalization attributable to angina, and a lower Seattle Angina Questionnaires summary score (all\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) compared with patients without MB. In particular, the group of patients with MB and a positive acetylcholine test had the worst prognosis.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Among patients with NOCAD, coronary spasm associated with MB may predict a worse clinical presentation with MINOCA and a higher rate of hospitalization attributable to angina at long\u2010term follow\u2010up with a low rate of hard events.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.020535","type":"journal-article","created":{"date-parts":[[2021,7,14]],"date-time":"2021-07-14T09:06:21Z","timestamp":1626253581000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":80,"title":["Interplay Between Myocardial Bridging and Coronary Spasm in Patients With Myocardial Ischemia and Non\u2010Obstructive Coronary Arteries: Pathogenic and Prognostic Implications"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6439-1018","authenticated-orcid":false,"given":"Rocco A.","family":"Montone","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo Luca","family":"Gurgoglione","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Pulmonary Sciences Catholic University of the Sacred Heart Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco Giuseppe","family":"Del Buono","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Pulmonary Sciences Catholic University of the Sacred Heart Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0559-2626","authenticated-orcid":false,"given":"Riccardo","family":"Rinaldi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Pulmonary Sciences Catholic University of the Sacred Heart Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Chiara","family":"Meucci","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Pulmonary Sciences Catholic University of the Sacred Heart Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Iannaccone","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Pulmonary Sciences Catholic University of the Sacred Heart Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4324-6348","authenticated-orcid":false,"given":"Giulia","family":"La Vecchia","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Pulmonary Sciences Catholic University of the Sacred Heart Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Camilli","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Pulmonary Sciences Catholic University of the Sacred Heart Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"D\u2019Amario","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Maria","family":"Leone","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocco","family":"Vergallo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Aurigemma","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonino","family":"Buffon","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"},{"name":"Department of Cardiovascular and Pulmonary Sciences Catholic University of the Sacred Heart Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1611-7708","authenticated-orcid":false,"given":"Enrico","family":"Romagnoli","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6569-9401","authenticated-orcid":false,"given":"Francesco","family":"Burzotta","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"},{"name":"Department of Cardiovascular and Pulmonary Sciences Catholic University of the Sacred Heart Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Trani","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"},{"name":"Department of Cardiovascular and Pulmonary Sciences Catholic University of the Sacred Heart Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Crea","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"},{"name":"Department of Cardiovascular and Pulmonary Sciences Catholic University of the Sacred Heart Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giampaolo","family":"Niccoli","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy"},{"name":"Department of Cardiovascular and Pulmonary Sciences Catholic University of the Sacred Heart Rome Italy"},{"name":"Department of Medicine and Surgery University of Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi203"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.43.1097"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.788901"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2015.02.013"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.01.049"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)02768-7"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.820720"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2007.05.030"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.1810140213"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2017.07.002"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4950260806"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2018.01.026"},{"key":"e_1_3_1_14_2","first-page":"91","article-title":"Patients with acute myocardial infarction and non\u2010obstructive coronary arteries: safety and prognostic relevance of invasive coronary provocative tests","volume":"39","author":"Montone RA","year":"2018","unstructured":"Montone RA, Niccoli G, Fracassi F, Russo M, Gurgoglione F, Camm\u00e0 G, Lanza GA, Crea F. 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