Beyond the ST segment: Multivessel disease and total coronary occlusion in Non-ST segment elevation myocardial infarction patients in Pakistan; A single center retrospective study

Abstract

Background and Objective: Non-ST segment elevation myocardial infarction (NSTEMI) may be associated with multivessel disease (MVD) and total coronary artery occlusion (TO); hallmarks of occlusive myocardial infarction (OMI). The study aimed to determine the frequency and predictors of MVD and TO in NSTEMI patients with OMI at a tertiary care center in Pakistan.

Methodology: This retrospective observational study analyzed the medical records of NSTEMI patients aged > 18 years, who underwent PCI at Indus Hospital and Health Network, Karachi, Pakistan, during 2022. Clinical features, electrocardiograph (ECG) and echocardiographic findings were reviewed. Univariate and multivariate logistic regression identified independent predictors of MVD and TO. Adjusted odds ratio (aORs) and 95% confidence intervals (CIs) were reported.

Results: Among the 671 NSTEMI patients (mean age 56.92 ± 11.29 years, 64% male), MVD and TO was detected in 35.42% and 33.72% respectively. Independent predictors for MVD included age >60 years (aOR 1.44, 95% CI: 1.01-2.04; p=0.045), chest pain at presentation (aOR 1.71, 95% CI: 1.18-2.49; p=0.005) and T-wave inversion (aOR 3.00, 95% CI: 1.92-4.67; p=<0.001). Predictors of TO included age < 60 years (aOR 0.68, 95% CI: 0.48-0.97; p=0.033), ST depression (aOR 1.70, 95% CI: 1.16-2.49; p=0.006) and absence of T-wave inversion (aOR 0.41, 95% CI: 0.27-0.62; p<0.001).

Conclusion: A significant subset of NSETMI patients in Pakistan present with underlying OMI. Simple clinical and ECG features may be helpful in identification of such high-risk cases in resource-limited settings; enabling timely intervention and improved outcome.