Angiographic Profile and Lesion Complexity in NSTEMI – Insights from a Comparative Analysis of Revascularization Strategies

Open Access

Abstract

Introduction: Non–ST-elevation myocardial infarction (NSTEMI) is a common presentation of acute coronary syndrome and is frequently associated with multivessel coronary artery disease (MVD), which increases the risk of adverse cardiovascular outcomes. Methods & Materials: This cohort study was conducted at the Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, over a 19-month period from December 01, 2022, to June 30, 2024. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 25.0. Result: The two patient groups were comparable in age, gender, and BMI, with chest pain being the predominant symptom and similar hemodynamic parameters observed (p > 0.05). Killip Class III heart failure was significantly more frequent in the Culprit-only PCI group (p = 0.020). Both groups showed minimal left main artery involvement, while significant LAD and LCx lesions were comparable. The Complete PCI group had a higher prevalence of RCA lesions (33% vs. 23.4%, p = 0.046). Angiographically, three-vessel disease and thrombus burden were significantly greater in the Culprit-only PCI group (TVD: 34.3% vs. 23.5%, p = 0.025; thrombus: p = 0.005). Conclusion: In patients with NSTEMI and multivessel coronary artery disease, the choice of revascularization strategy is primarily influenced by the extent and complexity of coronary lesions rather than patient demographics. Complete PCI was more frequently undertaken in those with less severe disease and lower thrombus burden, whereas culprit-only PCI was favored for patients with more complex anatomy and higher clinical risk.