Clinical profiles and angiographic patterns of patients undergoing coronary angiograms in two Hospitals in Nairobi

Abstract

Background An emerging principle threat in Africa is Coronary Artery Disease. Previous studies have focused on the analysis of risk factors of patient undergoing coronary angiography but no study has looked into the angiographic characteristic of this patient populations. Study objective The three primary objectives were first to determine the prevalence of angiographically confirmed CAD amongst patients undergoing coronary angiography. Secondly assess the risk factor profile of these patients with confirmed significant coronary artery disease and thirdly to determine the indications and describe the angiographic pattern of CAD in terms of vessel involvement (number and type) and severity of stenosis. The secondary objective was to determine a correlation between the risk factor burden (number of risk factors associated) and the severity of stenosis (number of vessel involved) Methodology A descriptive cross sectional study carried out in patients referred for coronary angiography in Kenyatta national Hospital and Nairobi West Hospital. Data on patient socio-demographics, risk factors and indication for coronary angiogram were collected from hospital records while the angiographic characteristics data was collected from analyzing images of coronary angiograms done each week under the expertise of two cardiologists. Results Ninety five patients who had been referred for diagnostic coronary angiography in Kenyatta National Hospital and Nairobi West hospital were screened for eligibility. A total of 90 patients were recruited; 44 of patients were from KNH and 46 from NWH. Of these 33(36%) were found to have normal epicardial vessels with no obstructive CAD while 57 (63%) had angiographically confirmed significant CAD with 1 or more obstructive lesion in the epicardial coronary arteries. The mean age of the patients with angiographically confirmed CAD was 57 years (SD 65.2) A male predominance was found with 64.9% of the participants being male resulting in a male to female ratio of 1.85:1. A great number of the participants resided in rural Kenya 39(43.9%) and had a primary level of education 25(43.9%). The prevalence of the risk factors evaluated in the study among patients with angiographically 12 confirmed obstructive CAD were as follows; Hypertension 50(87.7%), Diabetes 31 (54.4%), Dyslipidemia (56.1%), Smoking 19(33.3%), Obesity 16(28.1%) and family history of Premature CAD 2(3.5%). With respect to indications for coronary angiography, 36% of the patients had history of (ACS) STEMI/N-STEMI with 17.5% having stable angina (CCS class III/IV) and another 17.5% having unstable angina history. Angiographic analysis revealed that 35(61.4%) of the patients had single vessel disease, 15(23.3%) had double vessel disease, 7(12.3%) triple vessel disease and 8(7.2%) had left main disease. In relation to vessel involvement, left anterior descending (LAD) was the most common vessel diseased 40(36%) followed by left circumflex (LCX) 32(28.8%) and RCA 31(27.9%). Conclusion The most prevalent risk factor among patient with atherosclerotic CAD was found to be hypertension. Majority of the patients had single vessel disease with the most commonly involved epicardial vessel being LAD. A dose related response was seen where patients with more than three risk factors having more vessel involvement.