Prevalence of Multivessel Coronary Artery disease in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute ST-Elevation Myocardial Infarction at A Tertiary Care Hospital

Abstract

Background: Multivessel coronary artery disease (MCAD) substantially influences the clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PPCI). Nevertheless, data on the prevalence and clinical characteristics of multivessel disease in the Pakistani population are limited to a few studies. Objective: This study aimed to quantify the prevalence of MCAD in patients with STEMI undergoing PPCI and to identify the patient characteristics associated with MCAD at Lady Reading Hospital, Peshawar, Pakistan. Methods: This retrospective cohort study comprised of 450 consecutive patients diagnosed with acute STEMI who underwent PPCI at the Lady Reading Hospital in Peshawar between January and May 2025. Multivessel disease (MVD) was characterized by the presence of ≥70% stenosis in at least two major epicardial vessels or (≥50%) stenosis in the left main artery (LMA) in conjunction with one other vessel. This study analysed the clinical and angiographic findings. Results: The mean age of the study population was categorized as (53.4 ± 9.7) years, with a male predominance of 56.4%. (MCAD) was identified in 305 patients, accounting for 67.8% (95% CI: 63.5-72.1%) of the cohort. Patients diagnosed with MCAD were significantly noted older, having a mean age of (54.3 ± 10.0) compared to (51.4 ± 8.7) years in those without MCAD (P =0.003). The prevalence of diabetes mellitus (52.1% vs. 28.3%, P <0.001), hypertension (60.7% vs. 48.3%, P =0.018), and current smoking (35.1% vs. 20.7%, P =0.003) was predominantly higher in the MCAD group. Independent predictors of MVD included diabetes mellitus (OR 2.89, 95% CI: 1.78-4.29), current smoking (OR 2.07, 95% CI: 1.18-3.03), and hypertension (OR 1.76, 95% CI: 1.12-2.44). Conclusion: The incidence of MCAD among STEMI patients undergoing PPCI at our tertiary care centre in Pakistan was 67.8%, surpassing that in Western populations. Diabetes mellitus, smoking, and hypertension were the strongest predictors of MVD.