Factors associated with multivessel coronary artery disease in patients with acute myocardial infarction

Objective To determine the clinical, functional, laboratory, and anamnestic indicators associated with multivessel coronary artery (CA) disease in patients with acute myocardial infarction with ST segment elevation. Materials and methods A total of 922 patients hospitalized with AMI in 2024 were examined, of whom 600 (65.1%) were men. Multivessel coronary artery disease (MVCAD) was detected in 335 patients (36.3%). The analysis included the following factors: medical history, general clinical examination, laboratory tests (complete blood count, blood sugar, creatinine, K, Ca, Cl, Na, troponin I), echocardiography (ECG), and coronary angiography (CAG). Spearman's rank correlation coefficient was used to assess correlations with MVCAD. Results Patients with MVCAD were older (68.2±9.4 vs. 62.5±10.1 years, p<0.001), more likely to have hypertension (AH) (99.4% vs. 69.8%, p=0.002), diabetes mellitus (DM) (34.3% vs. 19.5%, p<0.001), and chronic kidney disease (18.8% vs. 8.9%, p=0.004). Patients with MVCAD had higher levels of creatinine (114±29 vs. 96±25 μmol/L, p=0.001), glycemia (7.4±2.3 vs 6.2±1.8 mmol/L, p=0.01), but no difference in troponin I level (3.8±1.5 vs 3.9±1.7 ng/mL, p=0.62). According to the complete blood count, they had higher white blood cell counts (11.4±3.1 vs. 9.8±2.7×10⁹/L, p=0.01) and slightly lower hemoglobin levels (128±14 vs. 134±13 g/L, p=0.03). The LV ejection fraction was lower in patients in the MVCAD group (46.1±7.8% vs 51.5±6.9%, p<0.001). It was found that patients with MVCAD had a high incidence of severe complications of AMI: cardiogenic shock – 57 patients (17.0%), pulmonary edema – 27 patients (8.1%), ventricular fibrillation – 19 patients (5.7%). Correlations were observed between detected MVCAD and the time from symptom onset to hospitalization (r = 0.42; p < 0.01), the presence of atherosclerotic lesions of the carotid arteries (r = 0.39; p < 0.01), and LVEF (r = –0.41; p < 0.01). Duration of AH (r = 0.35; p < 0.01), presence of DM (r = 0.31; p < 0.01), and reduced GFR <60 ml/min/1.73 m² (r = –0.37; p < 0.01) also showed a significant correlation with MVCAD. Previous use of antiplatelet agents had a weak negative correlation (r = –0.18; p < 0.05), indicating a certain protective effect of the medication. Conclusions Thus, multivessel coronary artery disease in patients with MI forms a high-risk group for the development of severe complications. The main factors correlated with MVCAD are the time to hospitalization, duration of hypertension, presence of diabetes mellitus, previous medication use, atherosclerotic lesions of the carotid arteries, LVEF, and reduced GFR. Early identification of such patients and a targeted approach to management can significantly improve the prognosis and reduce the incidence of severe complications.