Angiographically Significant Coronary Artery Disease of Non-Culprit Vessels in Patients with ST-Elevation Myocardial Infarction: Prevalence, Predictors and Patients’ Outcome

Background: ST-elevation myocardial infarction (STEMI) imposes substantial morbidity and mortality. There is sparse literature comparing STEMI patients with angiographically significant coronary artery disease of non-culprit vessels (NCV-CAD) to those with culprit-only coronary artery disease (CO-CAD).

Purpose: To evaluate the prevalence, predictors and outcome of STEMI patients with angiographically significant NCV-CAD versus CO-CAD patients.

Methods: All consecutive STEMI patients who underwent primary percutaneous coronary intervention at our medical center between the years 2000-2020 were included. Angiographically significant CAD was defined as ≥50% stenosis in left main artery and/or ≥90% in other epicardial arteries in accordance with the European Society of Cardiology guidelines. Patients were analyzed for baseline clinical and echocardiographic characteristics as well as outcomes.

Results: A total of 3,320 patients were included. Of them, 2,663 (80.2%) patients had CO-CAD and 657 (19.8%) patients had angiographically significant NCV-CAD. Independent predictors for angiographically significant NCV-CAD were age >50 years (OR, 1.45 [95% CI, 1.11 to 1.91]; P=0.007), male gender (OR, 1.34 [95% CI, 1.05 to 1.7]; P=0.021), diabetes (OR, 1.56 [95% CI, 1.29 to 1.9]; P=<0.001), non-smokers (OR, 1.21 [95% CI, 1.01 to 1.46]; P=0.044) and without family history (OR, 1.28 [95% CI, 1.02 to 1.6]; P=0.032). Cardiogenic shock and apical thrombus were more common among patients with angiographically significant NCV-CAD when compared to CO-CAD (6.1% vs 2.2%; P=

Conclusions: One-fifth of our STEMI patients had angiographically significant NCV-CAD. Older age, male gender, diabetes, non-smokers and without family history were independent predictors for NCV-CAD which was associated with higher mortality rates at all time points.