FREQUENCY OF MULTIVESSEL CORONARY ARTERY DISEASE IN PATIENT WITH INFERIOR WALL MYOCARDIAL INFARCTION AT FIRST PRESENTATION
DOI:
https://doi.org/10.71000/8n0esw60Keywords:
Angiography, Coronary Artery Disease, Electrocardiography, , Inferior Wall Myocardial Infarction, Multivessel Disease, Myocardial Infarction, Percutaneous Coronary Intervention.Abstract
Background: Inferior wall myocardial infarction (IWMI) is traditionally considered to have a better prognosis than other myocardial infarction types. However, emerging evidence suggests that a significant proportion of these patients may have underlying multivessel coronary artery disease (MVD), which can adversely affect outcomes and necessitate more aggressive management.
Objective: To determine the frequency of multivessel coronary artery disease in patients presenting with inferior wall myocardial infarction.
Methods: A cross-sectional study was conducted at the National Institute of Cardiovascular Diseases (NICVD), Karachi, over a period of six months. A total of 170 patients aged 18–65 years with confirmed IWMI within four hours of symptom onset and undergoing coronary angiography were enrolled through non-probability consecutive sampling. Patients with prior MI, PCI, CABG, renal or liver disease, and arrhythmias were excluded. Demographic, clinical, and angiographic data were collected. Data were analyzed using SPSS v24, with frequencies, means, and chi-square tests applied where appropriate.
Results: Among 170 patients, 71.8% were male and the mean age was 54.2 ± 8.6 years. Multivessel disease was found in 63.5% of patients, with triple-vessel disease seen in 35.3% and double-vessel disease in 28.2%. The right coronary artery (RCA) was the most frequently involved infarct-related artery (76.5%). Hypertension, diabetes, and smoking were common risk factors. Patients with multivessel disease had a higher frequency of these comorbidities.
Conclusion: A substantial proportion of patients presenting with IWMI had multivessel coronary artery disease. These findings highlight the importance of early angiographic assessment and comprehensive risk evaluation to optimize treatment strategies.
References
Benatti G, Gragnano F, Vignali L, Calabrò P, Gurgoglione FL, Niccoli G. Timing and modality of complete revascularization in patients presenting with ST-segment elevation myocardial infarction and multivessel coronary artery disease. Int J Cardiol. 2023;380:6-11.
Puymirat E, Cayla G, Simon T, Steg PG, Montalescot G, Durand-Zaleski I, et al. Three-Year Outcomes With Fractional Flow Reserve-Guided or Angiography-Guided Multivessel Percutaneous Coronary Intervention for Myocardial Infarction. Circ Cardiovasc Interv. 2024;17(6):e013913.
Freund A, Desch S, Thiele H. Revascularization in cardiogenic shock. Herz. 2020;45(6):537-41.
Erbay A, Penzel L, Abdelwahed YS, Heuberger A, Schatz AS, Seppelt C, et al. Prognostic impact of quantitative flow ratio (QFR)-consistent complete revascularization in patients with myocardial infarction and multivessel coronary artery disease. Am Heart J. 2024;276:22-30.
Omerovic E, Råmunddal T, Petursson P, Angerås O, Rawshani A, Jha S, et al. Percutaneous vs. surgical revascularization of non-ST-segment elevation myocardial infarction with multivessel disease: the SWEDEHEART registry. Eur Heart J. 2025;46(6):518-31.
Kakar H, Groenland FTW, Elscot JJ, Rinaldi R, Scoccia A, Kardys I, et al. Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Non-ST-Elevation Coronary Syndromes and Multivessel Disease: A Systematic Review and Meta-Analysis. Am J Cardiol. 2023;195:70-6.
Taggart DP. PCI versus CABG in coronary artery disease. Vascul Pharmacol. 2024;155:107367.
Omer MA, Brilakis ES, Kennedy KF, Alkhouli M, Elgendy IY, Chan PS, et al. Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Patients With Non-ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock. JACC Cardiovasc Interv. 2021;14(10):1067-78.
Rymer JA, Granger CB. Managing patients with ST-elevation myocardial infarction and multivessel disease: is the story complete? Eur Heart J. 2020;41(42):4111-3.
Mimoso J. Long-term recurrent events in ST-elevation myocardial infarction and multivessel disease: The impact of different revascularization strategies. Rev Port Cardiol. 2023;42(5):453-4.
Formica F, Gallingani A, Tuttolomondo D, Hernandez-Vaquero D, Singh G, Pattuzzi C, et al. Long-Term Outcomes Comparison Between Surgical and Percutaneous Coronary Revascularization in Patients With Multivessel Coronary Disease or Left Main Disease: A Systematic Review and Study Level Meta-Analysis of Randomized Trials. Curr Probl Cardiol. 2023;48(7):101699.
Diletti R, den Dekker WK, Bennett J, Schotborgh CE, van der Schaaf R, Sabaté M, et al. Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): a prospective, open-label, non-inferiority, randomised trial. Lancet. 2023;401(10383):1172-82.
Lee JM, Kim HK, Park KH, Choo EH, Kim CJ, Lee SH, et al. Fractional flow reserve versus angiography-guided strategy in acute myocardial infarction with multivessel disease: a randomized trial. Eur Heart J. 2023;44(6):473-84.
Böhm F, Mogensen B, Engstrøm T, Stankovic G, Srdanovic I, Lønborg J, et al. FFR-Guided Complete or Culprit-Only PCI in Patients with Myocardial Infarction. N Engl J Med. 2024;390(16):1481-92.
Dhaka M, Kumar T, Sharma A. Electrocardiogram predictors of multivessel disease in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Research in Cardiovascular Medicine. 2021;10:1-6.
Chowdhury A, Rahman A, Khalequzzaman, Islam MA. Early Detection of Multivessel Disease and Prevention of Short and Long Term Complications. 2020;8:2271-7.
Choi KH, Yang JH, Park TK, Lee JM, Song YB, Hahn JY, et al. Culprit-Only Versus Immediate Multivessel Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction Complicating Advanced Cardiogenic Shock Requiring Venoarterial-Extracorporeal Membrane Oxygenation. J Am Heart Assoc. 2023;12(10):e029792.
Lin S, Guan C, Wu F, Xie L, Zou T, Shi Y, et al. Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention in Patients With Chronic Total Occlusion and Multivessel Disease. Circ Cardiovasc Interv. 2022;15(2):e011312.
Laudani C, Occhipinti G, Greco A, Spagnolo M, Giacoppo D, Capodanno D. Completeness, timing, and guidance of percutaneous coronary intervention for myocardial infarction and multivessel disease: a systematic review and network meta-analysis. EuroIntervention. 2025;21(4):e203-e16.
Faro DC, Laudani C, Agnello FG, Ammirabile N, Finocchiaro S, Legnazzi M, et al. Complete Percutaneous Coronary Revascularization in Acute Coronary Syndromes With Multivessel Coronary Disease: A Systematic Review. JACC Cardiovasc Interv. 2023;16(19):2347-64.
Kirov H, Caldonazo T, Riedel LL, Tasoudis P, Moschovas A, Diab M, et al. Comparing outcomes between coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with left main or multivessel disease. Sci Rep. 2023;13(1):22323.
Choi KH, Lee SY, Park TK, Lee JM, Song YB, Hahn JY, et al. Cardiogenic shock complicating acute myocardial infarction and multivessel disease: revascularization strategy according to ischemic territory. Rev Esp Cardiol (Engl Ed). 2025;78(2):97-106.
Kubra G, Saghir T, Rasheed S, Rehan FH, Ali A, Abbas S. In-Hospital Outcomes of Female Patients With Inferior Wall Myocardial Infarction. Cureus. 2021 Feb 11;13(2):e13274.
Panda S, Sharma SK. Echocardiographic and Angiographic Profile of Patients with Lateral Wall MI ECG Presentation in Inferior Wall Mi (A Comparison Study). Scholars Journal of Applied Medical Sciences. 2020;8(11):2573-7
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Saba Zafar, Fawad Farooq, Ali Muhammad Mahar, Ali Hyder, Simran Ochani, Ahsan Ali Gaad, Tanzeel Rehman (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
