Aim To examine myocardial bridge-mural coronary artery (MB-MCA) by using coronary CT angiography (CTA) and coronary angiography (CAG); To investigate the clinical features of MB-MCA and correlation between its imaging indexes and myocardial ischemic symptoms. Methods MB cases were retrospectively analyzed in our hospital in recent years, and 152 cases of MB were selected and diagnosed by coronary CTA and CAG. According to whether there was atherosclerosis (As), 152 cases of MB were divided into simple MB group and As with MB group. According to whether there was myocardial ischemic symptom, 152 cases of MB were divided into symptomatic group and asymptomatic group. Clinical features and imaging data were analyzed and compared in each group. Correlation was analyzed between MB-MCA imaging indexes and myocardial ischemia symptoms. Results The detection rate of coronary artery CTA for MB was 11.4%, and the detection rate of CAG for MB was 10.1%, and both were close. MB-MCA features of 152 cases:Systolic compression degree was 50.1%±10.5%, diastolic compression degree was 22.8%±10.5%; The average length was 18.2±11.5 mm mm, and the thickness was 2.7±0.8 mm; The most common MB site was in the middle part of left anterior descending coronary artery (LAD) (60.7%). Incidence of myocardial ischemic symptoms (typical chest tightness, etc.) and positive rate of treadmill exercise test in As with MB group were significantly higher than those in simple MB group (75.5% vs 58.7%, 66.0% vs 43.5%, P＜0.001). Compared with the asymptomatic group, MB was more distributed in the middle part of LAD, and more easily complicated with As in the symptomatic group (86.9% vs 68.9%, 74.8% vs 57.8%, P＜0.001). Spearman correlation analysis showed that the MB thickness, MCA systolic and diastolic compression degree were positively correlated with the myocardial ischemic symptoms. Conclusions The detection rates of coronary CTA and CAG for MB are similar. Incidence of myocardial ischemic symptoms and positive rate of treadmill exercise test in patients with MB combined with As are higher than those in patients with simple MB. Myocardial ischemic symptoms in patients with MB are closely related to MB thickness, MCA compression degree and As.