Definition of Multivessel Coronary Artery Disease
Multivessel disease (MVD) is defined as angiographically significant stenosis of ≥50% in two or more major epicardial coronary arteries. 1
Anatomic Definition
- Stenosis severity threshold: ≥50% diameter reduction in at least two major epicardial coronary arteries 1
- Specific anatomic criteria: The three main coronary territories are the left anterior descending artery (LAD), left circumflex artery, and right coronary artery 2
- Three-vessel disease: Significant stenosis (≥70% diameter reduction) involving all three major coronary territories 2
Clinical Prevalence
- MVD is present in 40-70% of patients with acute coronary syndromes, making it a common finding in patients presenting with ACS 1
- Approximately 50% of patients with acute coronary syndrome have multivessel disease, which carries higher risk than single-vessel disease 3
Important Diagnostic Considerations
- Visual angiographic assessment has significant limitations, with only 70% concordance between observers for stenosis severity, dropping to 51% when restricted to vessels with some stenosis 2
- Physiological assessment with fractional flow reserve (FFR <0.80) may be necessary to define the true hemodynamic significance of intermediate lesions in multivessel disease 2, 4
- Noninvasive stress testing fails to correctly identify all ischemic areas in 90% of patients with multivessel disease, with 35% showing no perfusion defect possibly due to balanced ischemia 1
Prognostic Implications
- Multivessel disease entails higher risk of new ischemic events and worse prognosis compared to single-vessel disease 3
- The presence of proximal LAD involvement confers worse prognosis than distal disease 2
- Patients with diabetes and multivessel disease have preference for CABG over PCI due to improved outcomes 2, 5