A 20-Year Autopsy Study of Myocardial Bridging Among Sudden Deaths

Myocardial bridging (MB) is a condition, where the cardiac muscle overlies the intramyocardial segment of the major epicardial coronary artery. This study aims to analyse the demographics and anatomical characteristics of MB within a pool of 2093 sudden cardiac-related death cases examined at the Forensic Unit of Universiti Kebangsaan Malaysia Medical Centre between 2000 and 2019. In this cross-sectional study, postmortem data collected were gender, racial affiliations, MB anatomical properties, and association with cardiac pathologies entered into the statistical software SPSS version 25 for analysis. The prevalence of MB was 12.9%. It was commoner in males (91.5%). MB was predominant between age 21-40 years old (50.2%). Chinese race showed the highest number of recorded MB cases (24.3%) among local races. MB was mostly found in left anterior descending (LAD) artery (98.2%), with the commonest length of 11-20mm (44.6%), depth of 1-5mm (49.8%), and distance from the ostium of 21-40mm (54.0%). The prevalence of isolated MB (43.2%) was nearly comparable to that of MB with cardiac pathologies (56.8%). MB was mostly associated with atherosclerosis (50.1%) and atheroma formation was mostly proximal to MB (78.3%). MB is a common occurrence and commonly found in the LAD as a single entity. It has a higher preponderance in the male gender among the adult population. In conclusion, the findings not only contribute to a deeper understanding of MB but also hold potential implications for identifying and managing risks related to sudden cardiac-related deaths. It is a pathological condition at a certain length and depth whether it exists as an isolated entity or associated with cardiac pathologies. Atherosclerosis tends to form proximal to MB and might pose a risk for myocardial infarction.