Premature coronary artery disease, risk factors, clinical presentation, angiography and interventions: Hospital based registry

Abstract

Background & aimsPremature coronary artery disease (CAD) is endemic in India. We performed a study to identify risk factors, clinical presentation, angiographic findings and interventions in premature CAD. MethodsSuccessive patients who underwent percutaneous intervention (PCI) were enrolled from January 2018 to June 2021. Premature CAD was defined as women 45-59 y and men 40-54 y and very premature as women <45 y and men <40 y. Descriptive statistics are presented. Univariate odds ratio (OR) and 95% confidence intervals (95%CI) were calculated to identify differences in various groups. Results4672 patients (women 936, men 3736) were enrolled. Premature CAD was in 1238 (26.5%; women 31.9%; men 25.1%) and very premature in 212 (4.5%; women 6.5%, men 4.0%). In premature and very premature vs non-premature CAD, OR (95%CI) for high cholesterol ≥200 mg/dl [women 1.52(1.03–2.25) and 1.59(0.79–3.20); men 1.73(1.38–2.17) and 1.92(1.22–3.03)], non-HDL cholesterol ≥130 mg/dl [women 1.84(1.35–2.52) and 1.32(0.72–2.42); men 1.69(1.43–1.90) and 1.67(1.17–2.34)], LDL cholesterol [men 1.10(0.95–1.25) and 1.04(0.77–1.41)], and tobacco [women 1.40(0.84–2.35) and 2.14(0.95–4.82); men 1.63(1.34–1.98) and 1.27(0.81–1.97)] were higher while hypertension, diabetes and chronic kidney disease were more in non-premature(p < 0.05). Presentation as STEMI was marginally more in women with premature [1.13(0.85–1.51)] and very premature [1.29(0.75–2.22)] CAD and was significantly higher in men [1.35(1.16–1.56) and 1.79(1.29–2.49)]. Location and extent of CAD were not different. ConclusionsIn India, a third of CAD patients presenting for coronary intervention have premature disease. Important risk factors are high total and non-HDL cholesterol and tobacco (men) with greater presentation as STEMI. Extent and type of CAD are similar to non-premature CAD indicating severe disease.