Prevalence, Angiographic Findings, and Risk Factors for Premature Coronary Artery Disease in Patients Undergoing Coronary Angiography in Kenyatta National Hospital, Nairobi, Kenya

Abstract

Coronary Artery Disease (CAD) is the leading cause of global morbidity and mortality, increasingly affecting developing countries. While CAD usually occurs after the sixth decade, some populations experience it prematurely, with premature coronary artery disease (PCAD) rising notably in developing nations. Given the absence of such studies in Kenya, this research explores the prevalence, associated cardiovascular risk factors, and angiographic characteristics of premature coronary artery disease among patients undergoing invasive coronary angiography at Kenyatta National Hospital. This study adopted a hospital-based cross-sectional design, utilizing consecutive sampling to enroll 100 adult patients. Data on socio-demographic characteristics, risk factors, and indications for coronary angiography were collected from patient records and supplemented with questionnaires for missing information. Angiographic characteristics were obtained through weekly analyses of coronary angiograms performed by hospital interventional cardiologists. Data collection spanned six months, and statistical analyses were conducted using R version 4.1.2. Descriptive statistics were reported as means and standard deviations for continuous variables, while categorical data were summarized as counts and percentages. Associations between variables were assessed using Fisher’s exact tests, and a multivariable logistic regression model was fitted to identify risk factors for premature CAD after adjustment. The mean age of participants with premature CAD was 49.8 ± 8.5 years, compared to 69.9 ± 8 years for those with mature CAD. Abnormal angiographic findings were observed in 58 patients, with a premature CAD prevalence of 37.9% (95% CI: 25.8%, 51.7%). Bivariate analysis revealed that females had significantly higher odds of premature CAD compared to males (OR: 3.12, 95% CI: 1.04–9.79, p = 0.045). Males with premature CAD had a slightly lower age than that of females, though it was not statistically significant (47.2 ± 5.8 vs. 51.9 ± 10 years, p = 0.183). Smoking was significantly associated with premature CAD both before and after adjustment (OR: 0.23, 95% CI: 0.04–0.97, p = 0.045). Hypertension and diabetes mellitus were associated with lower odds of premature CAD compared to mature CAD. Most of the patients had multiple-vessel disease with severe stenosis, but no significant associations were found between risk factors and disease severity. The study concluded that premature coronary artery disease is alarmingly prevalent at Kenyatta National Hospital, with females at higher risk and smoking as a key contributing factor. Most patients in the study had severe obstructive coronary artery disease. These findings emphasize the need for targeted prevention strategies, particularly smoking cessation, to reduce the burden of PCAD in Kenya.