The Prevalence and Distribution of Multivessel Disease in Non-ST Elevation Myocardial Infarction

Abstract

Introduction: Non-ST Elevation Myocardial Infarction (NSTEMI) remains a common problem with an unacceptably high contribution to mortality beyond discharge. Patients with unrevascularised multi-vessel disease (MVD) are at particular risk but data on the prevalence and distribution of MVD in the NSTEMI cohort is limited. Using the Coronary Angiogram Database of South Australia (CADOSA), consecutive NSTEMI patients presenting to 3 tertiary hospitals between 2012 and 2016 were assessed in prevalence, distribution and key predictors of MVD. Methods: MVD was defined as the presence of significant lesions in ≥2 major epicardial vessels (≥50% stenosis in the left main or ≥70% stenosis in the other vessels by visual angiographic assessment). Patients with previous CABG and lesions defined only qualitatively were excluded. Results: Of 3,722 patients, 1,524 (40.9%) were found to have MVD, 20.7% with 2-vessel disease (2-VD) and 20.2% with 3-vessel disease (3-VD). Disease distribution is shown in Table 1. LAD involvement was most common. The prevalence of LM disease increased when 3-VD was present. Age, male gender, smoking and diabetes were significant predictors of MVD (p < 0.001). Conclusions: Multivessel coronary disease affects approximately two in five patients presenting with NSTEMI. Further analysis will determine how the presence of MVD impacts on management strategy and outcomes.