الفهرس 
EPIDEMIOLOGY & RISK FACTORS OF CADOnly 14 pages are availabe for public view
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Abstract
T
his retrospective observational study was conducted on 191 Egyptian patients who were suspected to have premature coronary artery disease and were referred to the catheterization lab. The main objectives of the study were to evaluate the disease in terms of major risk factors, mode of presentation, coronary angiographic analysis and outcome. Their mean age was 36 ±3.6 years with the age range between 17 and 39 years. Males represented the majority of patients (92.7%).
The available data were analyzed; clinical data were obtained from all patients including: age, gender, traditional risk factors of atherosclerosis (e.g.: Hypertension, diabetes mellitus, smoking, dyslipidemia and family history of premature coronary disease), mode of presentation (unstable angina, STEMI, non STEMI, chronic stable angina). General and local examination data and electrocardiographs were available for all patients. Echocardiography reports were available only for 121 patients. All patients’ in-hospital follow up data were available and were analyzed for complications and management. Coronary angiography films for all the patients were revised and analyzed.
According to the results, smoking was the most prevalent risk factor (67%), followed by dyslipidemia and family history of premature coronary artery disease. Most of the patients presented with one or two risk factors (35.6%) and (27.7%) respectively. 19 patients underwent previous coronary intervention and 6 patients underwent previous coronary bypass surgery. Anginal pain was the leading symptom (95.8%), of which (67.8%) described chest pain as their first attack. STEMI was documented in 56 patients (29.3%), while most patients presented with unstable angina (59.7%), only one patient presented with bradycardia and syncope, while three patients presented with either ventricular fibrillation or non-sustained ventricular tachycardia.
Major complications were less likely to occur in this age group; however we documented impairment of left ventricular systolic function in (28.9%) in the available 121 echocardiography reports.
Angiographically; we were able to document 148 patients (77.5%) with coronary abnormalities, including coronary atherosclerotic disease, thrombus formation, calcification and abnormal TIMI flow patterns; in those patients we documented the total severity of atherosclerotic coronary artery disease using Gensini scoring system (Mean= 45.7±41). Abnormal TIMI flow with or without luminal stenosis was found in (55.4%) of them, however we noticed that (7.4%) of the 148 patients had abnormal TIMI flow without angiographically apparent CAD. Thrombosis and calcification were less likely detected. Single vessel disease was detected in (33.1%) whereas multivessel disease was detected in (59.5%) of them. Left anterior descending artery was the most affected one with predominant affection of its proximal and middle segments; left main coronary artery was rarely diseased.
Based on the angiographic findings; patients with documented coronary disease were recommended for medical or revascularization therapy (coronary intervention or bypass surgery). Most of them underwent PTCA±PCI (n=92), a small group of them were referred to coronary bypass surgery (n=16), the rest of them (n=40) were kept on regular drug therapy. This study reflected the behavior of premature coronary disease and its outcome; it also gave a good idea about the prevalent risk factors in this entity that can be controlled to minimize the prevalence of the disease.