COMPARATIVE ANALYSIS OF IN-HOSPITAL CLINICAL OUTCOMES AMONG PATIENTS WITH ACUTE ANTERIOR AND INFERIOR WALL ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION AT A TERTIARY CARE HOSPITAL, PESHAWAR

Abstract

Acute myocardial infarction (AMI) remains a major cause of morbidity and mortality worldwide, and anterior wall myocardial infarction (AWMI) and inferior wall myocardial infarction (IWMI) exhibit distinct clinical characteristics and in-hospital outcomes. Local, region-specific comparative data from Pakistan remain limited. This study aimed to compare in-hospital clinical outcomes among patients with acute AWMI and IWMI admitted to a tertiary care hospital in Peshawar. A comparative cross-sectional study was conducted on 384 patients with confirmed ST-segment elevation myocardial infarction (STEMI), comprising 192 patients with AWMI and 192 with IWMI, recruited by non-probability convenience sampling. Data were collected using a structured proforma and analyzed using IBM SPSS version 26; the Chi-square test was used for categorical variables and the independent-samples t-test for continuous variables, with p ≤ 0.05 considered significant. The AWMI group had a mean age of 58 ± 10 years (150, 78.1% male) and the IWMI group a mean age of 56 ± 11 years (155, 80.7% male). Hypertension was present in 57.3% of AWMI and 56.3% of IWMI patients, and diabetes mellitus in 44.3% and 42.7%, respectively. Patients with AWMI experienced a higher frequency of adverse outcomes than those with IWMI: cardiogenic shock (15.6% vs 10.4%), acute heart failure (20.8% vs 12.5%), cardiac arrest (5.2% vs 2.6%), and in-hospital mortality (12.0% vs 8.9%). Left bundle branch block was more common in AWMI (14.1% vs 2.6%), whereas atrioventricular block was more frequent in IWMI (16.7% vs 2.1%). The association between MI type and heart failure was statistically significant (χ² = 4.79, p = 0.029), and hospital stay was significantly longer in AWMI patients (5.59 ± 2.51 vs 3.50 ± 2.50 days; t = 8.10, p < 0.001). These findings indicate that patients with acute AWMI have poorer in-hospital outcomes and a higher risk of major complications and mortality than those with IWMI, underscoring the need for early risk stratification and prompt reperfusion therapy, particularly in resource-limited settings.