Cangrelor significantly reduced the rate of ischemic events, including stent thrombosis, during PCI, with no significant increase in severe bleeding. (Funded by the Medicines Company; CHAMPION PHOENIX ClinicalTrials.gov number, NCT01156571.).

Myocardial infarction may occur without atherosclerotic lesions discernible by coronary angiography. The impact of this phenomenon may not be appreciated by many clinicians largely because of a priori assumptions that patients who present with a history of MI or angina syndrome are victims of atherosclerosis and fit well into mainstream management ranging from acute care to rehabilitation. In the absence of atherosclerosis, myocardial infarction may result from several etiologies by chronic hypoperfusion if the culprit artery has a course within the myocardium rather than a more epicardial course. These vessels, called tunnelled arteries, are typically traversed by thick bundles of muscle fibres that comprise a myocardial bridge. They are characterized by chronically abnormal hemodynamics that are prone to exacerbation, leading to anginal symptoms and myocardial infarction. A case history is presented that describes the presentation, medical evaluation and treatment, and rehabilitation of a patient with non-atherosclerotic MI attributed to a myocardial bridge. It is followed by a review of the pathophysiology of this medical problem and efficacy of various treatments. Rehabilitation considerations that apply to patients with a tunnelled coronary artery are discussed.

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