Clinical Outcomes of Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients with Triple Vessel Coronary Artery Disease

Abstract

Objectives: To determine the frequency of adverse clinical outcomes among patients presenting with ST-segment elevation myocardial infarction (STEMI) and triple vessel coronary artery disease (TVD) undergoing primary percutaneous coronary intervention (PCI). Methodology: This prospective observational cohort study was conducted at the Department of Cardiology, Chaudhary Pervez Elahi Institute of Cardiology, Multan, Pakistan, from July 2024 to December 2025. Patients aged 30–60 years presenting within 12 hours of STEMI or new-onset left bundle branch block (LBBB) and undergoing primary PCI were included. Baseline demographic and clinical characteristics were recorded, including diabetes mellitus, hypertension, dyslipidemia, smoking status, and family history of coronary artery disease. The primary outcomes included in-hospital and six-month mortality, stroke, and recurrent myocardial infarction (MI). Statistical analysis was performed using SPSS version 26. Chi-square or Fisher’s exact tests were applied for comparison, and risk ratios (RR) with 95% confidence intervals (CI) were calculated. Results: A total of 111 patients were included in the study, of whom 79 (71.2%) were male and 32 (28.8%) were female, with a median age of 52.0 years (46.0–58.0). During hospitalization, death occurred in 5 patients (4.5%), stroke in 3 patients (2.7%), and recurrent MI in 3 patients (2.7%). At six-month follow-up, cumulative mortality increased to 10 patients (9.0%), stroke to 4 patients (3.6%), and recurrent myocardial infarction to 8 patients (7.2%). Composite adverse clinical events were significantly more frequent among patients with diabetes mellitus (RR 2.9, p=0.007), hypertension (RR 2.4, p=0.030), and dyslipidemia (RR 2.6, p=0.018). Conclusion: Clinically significant adverse outcomes were observed during hospitalization and within six months among patients with STEMI and triple vessel coronary artery disease undergoing primary PCI. Cardiometabolic risk factors, particularly diabetes mellitus, hypertension, and dyslipidemia, were associated with increased risk of adverse outcomes, highlighting the importance of aggressive secondary prevention strategies and structured follow-up in this high-risk population.