Comparison of Left Ventricular Dysfunction in STEMI Patients with RCA versus LCX Lesions Undergoing Primary PCI

Abstract

Objectives: To compare the frequency and severity of LV dysfunction in patients undergoing primary percutaneous coronary intervention (PPCI) for STEMI with RCA versus LCX as the culprit vessel. Methodology: This prospective observational study was conducted over six months at a tertiary cardiac care center. A total of 128 patients with ECG-confirmed STEMI undergoing PPCI were consecutively enrolled, including 64 with RCA lesions and 64 with LCX lesions. Demographic data, cardiovascular risk factors, and procedural details were recorded. Post-procedure LV function was assessed 24–48 hours after PPCI using echocardiography. LV dysfunction was categorized as mild (EF >50%), moderate (EF 36–50%), or severe (EF ≤35%). Statistical analysis included independent t-tests for continuous variables and chi-square tests for categorical comparisons, with significance set at p<0.05. Results: The mean EF was significantly higher in patients with RCA lesions (48.7 ± 7.6%) compared with LCX lesions (42.3 ± 8.4%, p = 0.002). Severe LV dysfunction (EF ≤35%) was observed in 32.8% of LCX patients versus 17.2% of RCA patients (p = 0.01). Risk stratification showed diabetes mellitus to be strongly associated with more severe LV impairment in LCX cases, while gender differences were not statistically significant. Conclusion: STEMI patients with LCX-related infarction undergoing PPCI are at greater risk of developing moderate to severe LV dysfunction compared to those with RCA occlusions. These findings highlight the need for early recognition, close monitoring, and aggressive management strategies in patients with LCX involvement.