Frequency of Multivessel Coronary Artery Disease in Patients with Non-ST-Segment Elevation Myocardial Infarction and TIMI Score ≥4

Abstract

Objective: To determine the frequency of multivessel coronary artery disease (MVCAD) among patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) and a Thrombolysis in Myocardial Infarction (TIMI) score ≥4 and to evaluate its association with demographic and clinical characteristics. Methodology: This analytical cross-sectional study was conducted at Tabba Heart Institute, Karachi, Pakistan, between September and November 2025. Consecutive adult patients presenting with NSTEMI and a TIMI score ≥4 who underwent coronary angiography during the index hospitalization were enrolled. MVCAD was defined as ≥70% luminal stenosis involving at least two major epicardial coronary arteries. Clinical and angiographic data were collected prospectively using standardized institutional records. Associations between clinical characteristics and MVCAD were examined using univariate analyses, followed by multivariable binary logistic regression to identify independent predictors after adjustment for potential confounders. Results: A total of 183 patients were included in the study. The mean age was 60.64 ± 8.69 years, and 68.9% were male. The mean TIMI score was 4.62 ± 0.62. Coronary angiography demonstrated MVCAD in 138 patients (75.4%; 95% CI: 68.7–81.2). On univariate analysis, hypertension (p=0.001) and diabetes mellitus (p<0.001) were significantly associated with MVCAD. Although MVCAD was more frequent among patients with TIMI scores ≥6 than among those with TIMI scores of 4–5 (100.0% vs. 73.8%), this difference did not achieve statistical significance (Fisher's exact p=0.068). Multivariable logistic regression demonstrated that hypertension (adjusted odds ratio [aOR] 3.98, 95% CI: 1.84–8.70; p<0.001) and diabetes mellitus (aOR 4.65, 95% CI: 2.13–10.20; p<0.001) were independent predictors of MVCAD, whereas TIMI score was not independently associated with multivessel disease (aOR 1.53, 95% CI: 0.84–2.79; p=0.170). Conclusion: Multivessel coronary artery disease was highly prevalent among patients presenting with NSTEMI and TIMI score ≥4. Hypertension and diabetes mellitus independently predicted multivessel coronary involvement, whereas TIMI score was not independently associated with angiographic disease severity after adjustment for conventional cardiovascular risk factors. Larger prospective multicenter studies are warranted to validate these findings and compare the predictive performance of established cardiovascular risk stratification tools.