P5487Premature coronary artery disease among Egyptian patients with acute coronary syndrome; data from the cross-sectional cardio-risk project

Abstract

Abstract Background Egypt is the most populous country in Middle East and North Africa and has one of the highest rates of the cardiovascular (CV) deaths in the region. Despite governmental primary preventive efforts, very little is known about the prevalence and characteristics of premature coronary artery disease (CAD) among Egyptian patients with Acute Coronary syndrome (ACS). Methods From November 2015 to August 2018, data were collected from 3224 patients with ACS in 30 coronary care centers covering 11 governorates across Egypt, spanning the Mediterranean coast, Nile Delta, and Upper Egypt, with focus on premature CAD (defined as ACS before age 55 years in males and 65 years in females). Results The prevalence of premature CAD was 51%. They were significantly more females (35% versus 16%, P<0.001) with significantly higher level of education. Risk factors' (RFs) distribution showed a significantly higher prevalence of Type-1 Diabetes Mellitus (6% versus 4%, P=0.005), obesity (42% versus 33%, P<0.001) and smoking (50% versus 47%, P<0.001) in patients with premature CAD when compared to others. Interestingly, rates of documented dyslipidemia were similar between groups (49% versus 47%, P=0.45) with no significant difference in low density lipoprotein-cholesterol levels (131.7±48.5 versus 130.2±45.2 mg/dl, P=0.4). Patients with premature CAD tended to present more frequently with ST-elevation myocardial infarction (STEMI) (50% versus 46%, P=0.035), with higher rates of treatment using primary percutaneous coronary intervention compared to others (48% versus 44%, P=0.04). They were also significantly less likely to receive Coronary Artery Bypass Graft (4% versus 6.5%, P=0.003). Conclusion Prevalence of premature CAD is high among Egyptian patients with ACS, due to noticeably larger burden of traditional CV RFs especially smoking and possibly familial hypercholesterolemia. Much effort is still needed in screening for early detection of RFs of atherosclerosis together with more widespread adoption of diagnostic scores for FH such as Dutch Lipid Network criteria. Acknowledgement/Funding AstraZeneca