Multivessel disease in patients with ST-segment elevation myocardial infarction. Evolution and hospital complications (ARGEN-IAM Registry)

Abstract

Background: Multivessel disease (MVD) in acute myocardial infarction (AMI) is a frequent entity. Multiple studies describe more severe forms of presentation and worse prognosis during hospitalization. Objective: To know the evolution and complications of cases with MVD included in the ARGEN–IAM ST registry. Methods: The cases of the ARGEN-IAM ST registry were included. According to the findings in coronary angiography, 2 groups were defined; Injury of a single vessel (SV) and injury of two or more vessels (MV) with severe disease (including the culprit vessel). Those without coronary lesions were excluded. Results: There were 2614 cases included, 1674 (64%) with SV disease and 940 (36%) with MVD. Patients with MVD were older (63±12 vs. 60±12 years; p<0.0001), had more diabetes (25% vs 19%; p<0.0001) and high blood pressure (61% vs 55%; p=0.001). In admission, the previous location by electrocardiogram was SV 50% and MV 45%. (p=0.03) MVD patients evolved with more heart failure (17% vs. 11%; p<0.0001) and cardiogenic shock (13% vs 7%; p<0.0001). In-hospital mortality was at 5.5% in SV and 12% in MVD patients (p <0.0001). In the multivariate analysis, the presence of MVD, age and diabetes were independent predictors of hospitalization mortality (OR 2.07; CI 1.5-2.7; p<0.0001). Conclusions: In the studied population, 36% of acute myocardial infarctions had multiple vessel disease, and presented a higher proportion of cardiovascular risk factors. During hospitalization, they had worse evolution and more complications. The presence of multiple vessels proved to be an independent predictor of higher mortality.