Prevalence and Factors Associated with Left Main and Proximal Left Anterior Descending Coronary Artery Disease among Patients Presenting with Acute Inferior Wall Myocardial Infarction: A Prospective Observational Study

Abstract

Objective: This study aimed to determine the prevalence of significant left main (LM) and proximal left anterior descending (pLAD) coronary artery disease and to identify factors associated with their presence in patients presenting with acute inferior wall myocardial infarction (IWMI). Methodology: A prospective observational cross-sectional study was conducted at a tertiary care cardiac center between February and August 2022. Ninety-six consecutive adult patients presenting with acute IWMI underwent coronary angiography and were included in the analysis. Significant coronary artery disease was defined as ≥50% stenosis in the LM coronary artery and ≥70% stenosis in the pLAD artery. Results: A total of 96 patients were enrolled, including 63 males (65.6%) and 33 females (34.4%), with a mean age of 57.8 ± 10.4 years. Isolated LM disease was identified in 1 patient (1.0%), isolated pLAD disease in 44 patients (45.8%), and combined LM and pLAD involvement in 6 patients (6.3%). Overall, pLAD involvement was present in 52.1% of patients, while LM involvement was observed in 7.3%. Hypertension (52.1%) and diabetes mellitus (37.5%) were the most prevalent cardiovascular risk factors. Multivariable logistic regression demonstrated that hypertension (adjusted OR = 1.96, 95% CI: 1.10–3.50; p = 0.01), diabetes mellitus (adjusted OR = 2.67, 95% CI: 1.30–5.51; p = 0.001), and family history of coronary artery disease (adjusted OR = 3.09, 95% CI: 1.43–6.82; p < 0.001) were independently associated with the presence of LM and/or pLAD disease. Conclusion: Significant proximal LAD involvement was common among patients presenting with acute IWMI, whereas left main coronary artery disease occurred less frequently. Traditional cardiovascular risk factors, particularly hypertension, diabetes mellitus, and family history of coronary artery disease, were independently associated with the presence of LM and/or pLAD disease.