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

ABSTRACT

Background & aims: Premature 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. Methods: Successive 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. Results: 4672 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 _x0001_200 mg/dl [women 1.52(1.03 e2.25) and 1.59(0.79e3.20); men 1.73(1.38e2.17) and 1.92(1.22e3.03)], non-HDL cholesterol _x0001_130 mg/dl [women 1.84(1.35e2.52) and 1.32(0.72e2.42); men 1.69(1.43e1.90) and 1.67(1.17e2.34)], LDL cholesterol [men 1.10(0.95e1.25) and 1.04(0.77e1.41)], and tobacco [women 1.40(0.84e2.35) and 2.14(0.95e4.82); men 1.63(1.34e1.98) and 1.27(0.81e1.97)] 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(0.85e1.51)] and very premature [1.29(0.75e2.22)] CAD and was significantly higher in men [1.35(1.16e1.56) and 1.79(1.29e2.49)]. Location and extent of CAD were not different. Conclusions: In 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.