High Prevalence of Multivessel Disease in Premature Coronary Artery Disease Presenting with STEMI: Evidence from a Tertiary Cardiac Centre

Abstract

Objective: To determine the frequency of multivessel coronary artery disease (MVD) in patients with premature coronary artery disease (PCAD) presenting with ST-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PCI). Methodology: This prospective descriptive cross-sectional study was conducted at the Department of Cardiology, Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, from 01-02-2024 to 31-01-2025. A total of 171 patients with premature CAD (males <45 years; females <55 years) presenting with STEMI and treated with primary PCI were enrolled. Multivessel disease was defined as ≥70% stenosis in at least two major epicardial coronary arteries or ≥50% stenosis of the left main trunk on coronary angiography confirmed by quantitative coronary angiography (QCA). Associations were assessed using chi-square testing, and multivariable logistic regression was performed to identify independent predictors. Results: The mean age was 41.06 ± 5.67 years, and 86.5% of patients were male. Multivessel disease was identified in 79 (46.2%) patients. Stratified analysis showed no statistically significant association between MVD and demographic or conventional cardiovascular risk factors (all p > 0.05). On multivariable analysis, diabetes (OR = 1.953; 95% CI: 0.913–4.178) and obesity (OR = 2.068; 95% CI: 0.829–5.160) were associated with higher odds of MVD, although these did not reach statistical significance. Conclusion: Nearly half of patients with premature CAD undergoing primary PCI had multivessel disease. Although traditional risk factors did not show statistically significant independent associations, the high burden of MVD in this young population underscores the need for aggressive risk assessment and preventive strategies.