Coronary artery disease (CAD) remains one of the most prevalent cardiovascular disorders and a leading cause of morbidity and mortality worldwide.1,2 It is primarily caused by the progressive accumulation of atherosclerotic plaques within the coronary arteries, which results in narrowing of the arterial lumen and reduced myocardial blood supply.3 The clinical manifestations of CAD range from stable angina to acute coronary syndromes, myocardial infarction, and sudden cardiac death.4 Despite advances in preventive strategies, pharmacological therapies, and revascularization techniques, CAD continues to impose a substantial burden on healthcare systems globally.5 Early identification of disease severity and accurate risk stratification are therefore essential for improving patient outcomes and guiding appropriate treatment strategies.

The anatomical extent of coronary artery involvement plays a crucial role in determining prognosis and therapeutic decision-making in patients with CAD.6 Patients may present with single-vessel coronary artery disease (SVCAD), where only one major epicardial coronary artery is affected, or multivessel coronary artery disease (MVCAD), where two or more major coronary arteries exhibit significant stenosis.7 Numerous clinical studies have demonstrated that multivessel disease is generally associated with more extensive myocardial ischemia, greater plaque burden, and a higher risk of adverse cardiovascular events compared with single-vessel disease.8 In contrast, patients with SVCAD often have a relatively localized disease process and tend to experience more favorable clinical outcomes, particularly when appropriate revascularization strategies are implemented.9

In recent years, the evaluation of coronary artery disease has moved beyond simple identification of the number of diseased vessels toward more comprehensive assessment of lesion complexity and anatomical characteristics.10 One of the most widely used tools for this purpose is the SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score, an angiographic scoring system that quantifies the complexity of coronary lesions based on factors such as lesion location, length, bifurcation involvement, total occlusion, calcification, and vessel tortuosity.11 The SYNTAX score provides an objective and standardized method for assessing the severity and complexity of coronary artery disease and plays an important role in guiding decisions regarding optimal revascularization strategies, including percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).12

Based on the calculated value, the SYNTAX score categorizes patients into three groups: low (≤22), intermediate (23–32), and high (≥33) anatomical complexity. Patients with low SYNTAX scores are generally considered suitable candidates for PCI, whereas those with high scores often derive greater benefit from surgical revascularization. However, the management of patients with intermediate SYNTAX scores remains more challenging because this group represents a transitional category with moderate lesion complexity. Treatment decisions in such cases often depend on additional clinical and anatomical factors, and there is ongoing debate regarding the optimal therapeutic approach.

Although the SYNTAX score has been extensively studied in patients with multivessel coronary artery disease and left main disease, relatively fewer studies have focused on comparing clinical outcomes between patients with single-vessel coronary artery disease and those with multivessel 

Study Design and Setting: This comparative observational study was conducted in the Department of Cardiology at Lady Reading Hospital,Peshawar, one of the largest tertiary care teaching hospitals in the region providing advanced cardiac diagnostic and interventional services. The hospital serves a large population from Peshawar and surrounding districts of Khyber Pakhtunkhwa. The study was designed to evaluate and compare clinical outcomes between patients with single-vessel coronary artery disease and those with multivessel coronary artery disease with intermediate SYNTAX scores. Ethical approval for the study was obtained from the institutional review committee prior to the commencement of data collection.

Study Population

Patients who presented to the cardiology department and underwent diagnostic coronary angiography for suspected or confirmed coronary artery disease were considered for inclusion in the study. Based on angiographic findings, the patients were categorized into two groups: those diagnosed with single-vessel coronary artery disease (SVCAD) and those with multivessel coronary artery disease (MVCAD) with intermediate SYNTAX scores ranging between 23 and 32. These groups were then compared to assess differences in clinical characteristics and outcomes.

Inclusion and Exclusion Criteria: The study included adult patients aged 18 years and above with angiographically confirmed coronary artery disease who had complete clinical and angiographic records. Patients diagnosed with either single-vessel disease or multivessel disease with an intermediate SYNTAX score were eligible for participation. However, patients with low or high SYNTAX scores outside the intermediate range, those with significant left main coronary artery disease, patients who had previously undergone coronary artery bypass graft surgery, and those with incomplete medical records or missing follow-up information were excluded from the stud

Data Collection: Demographic, clinical, and laboratory data were collected from hospital medical records and patient files. The collected variables included age, gender, body mass index, and cardiovascular risk factors such as hypertension, diabetes mellitus, smoking status, dyslipidemia, and family history of coronary artery disease. Clinical presentation at admission, including stable angina, unstable angina, or myocardial infarction, was also recorded. In addition, angiographic findings were reviewed to identify the number of diseased vessels, lesion location, and involvement of major coronary arteries

SYNTAX Score Assessment: The SYNTAX score was calculated for each patient using the standard angiographic scoring method that evaluates the complexity of coronary artery lesions. This scoring system takes into account multiple lesion characteristics including lesion location, bifurcation involvement, total occlusion, calcification, and vessel tortuosity. Based on the calculated value, patients with scores ranging between 23 and 32 were categorized as having intermediate anatomical complexity and were included in the multivessel disease group for comparison.

Outcome Measures: The primary outcome of the study was the occurrence of major adverse cardiovascular events (MACE) during the follow-up period. These events included all-cause mortality, non-fatal myocardial infarction, repeat revascularization procedures, and hospitalization due to unstable angina or heart failure. Secondary outcomes included procedural success rates and short-term complications following coronary intervention.

Statistical Analysis: All collected data were entered and analyzed using the Statistical Package for Social Sciences (SPSS). Continuous variables were expressed as mean ± standard deviation, whereas categorical variables were presented as frequencies and percentages. Comparisons between the two study groups were performed using the independent sample t-test for continuous variables and the chi-square test for categorical variables. A p-value of less than 0.05 was considered statistically significant for determining differences between the groups.

A total of 120 patients diagnosed with coronary artery disease were included in the study. Among them, 60 patients had single-vessel coronary artery disease (SVCAD) and 60 patients had multivessel coronary artery disease (MVCAD) with intermediate SYNTAX scores (23–32). Baseline demographic characteristics, clinical risk factors, angiographic findings, and clinical outcomes were compared between the two groups.

                                        Table 1: Baseline Demographic Characteristics of the Study Population

Interpretation:
Patients with multivessel disease were slightly older than those with single-vessel disease, although gender distribution was similar in both groups.

Table 2: Distribution of Cardiovascular Risk Factors

Interpretation:
Hypertension and diabetes mellitus were significantly more common among patients with multivessel coronary artery disease.

Table 3: Angiographic Characteristics of the Study Population

Interpretation:
Patients with multivessel disease demonstrated significantly greater angiographic complexity and higher SYNTAX scores.

Table 4: Clinical Outcomes and Major Adverse Cardiovascular Events (MACE)

Interpretation:
Major adverse cardiovascular events were significantly higher in patients with multivessel coronary artery disease with intermediate SYNTAX scores compared with patients having single-vessel disease.

Coronary artery disease remains one of the leading causes of morbidity and mortality worldwide. The extent of coronary artery involvement plays a crucial role in determining disease severity, management strategies, and patient outcomes. In the present study, we compared clinical characteristics and outcomes between patients with single-vessel coronary artery disease and those with multivessel coronary artery disease with intermediate SYNTAX scores. The findings suggest that patients with multivessel disease have a higher burden of cardiovascular risk factors and experience comparatively poorer clinical outcomes.

In our study, patients with multivessel coronary artery disease showed a higher prevalence of risk factors such as hypertension and diabetes mellitus compared with patients with single-vessel disease. These findings are consistent with previous research demonstrating that metabolic and vascular risk factors significantly contribute to the progression and complexity of coronary artery disease. Such risk factors accelerate atherosclerotic plaque formation and promote diffuse arterial involvement, leading to multivessel disease.

Angiographic evaluation also revealed greater anatomical complexity among patients with multivessel disease. The involvement of multiple coronary arteries results in a larger area of myocardial ischemia, which may explain the higher incidence of adverse cardiovascular events observed in this group. In contrast, patients with single-vessel disease typically have a more localized disease process and therefore tend to have better clinical outcomes following appropriate treatment.

The present study also demonstrated that major adverse cardiovascular events, including repeat revascularization and recurrent angina requiring hospitalization, were more common among patients with multivessel coronary artery disease. This may be attributed to the greater extent of atherosclerotic burden and lesion complexity associated with multivessel involvement. The findings highlight the importance of careful clinical and angiographic assessment in patients with intermediate SYNTAX scores in order to determine the most appropriate therapeutic strategy.

Overall, the results of this study emphasize that the anatomical extent of coronary artery disease remains an important determinant of clinical outcomes. Early identification and effective management of cardiovascular risk factors, along with appropriate revascularization strategies, may help improve prognosis in patients with multivessel coronary artery disease.

Patients with multivessel coronary artery disease and intermediate SYNTAX scores have higher cardiovascular risk and worse clinical outcomes compared with single-vessel disease. Careful risk assessment and appropriate management strategies, guided by the SYNTAX score, are essential to improve prognosis and reduce adverse events.

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