Background: The severity of coronary lesions in patients with coronary artery disease (CAD) has important prognostic and therapeutic consequences. Clinical symptoms not always reflect the disease severity and this study aimed to evaluate coronary lesions in the Algerian population where these data are scarce. Methods: It was a prospective cross-sectional study conducted in consecutive patients with an age ≥20 years who underwent clinically-indicated coronary angiography in our center. The objective of the study was to determine the prevalence of severe coronary lesions assessed with the Gensini score. The predictive factors of severity were evaluated in a multivariate analysis. Results: A total of 507 patients were included (male, 79.7%; mean age, 58.8 years). Coronary angiography was prescribed most frequently for ST-segment elevation myocardial infarction (STMI) (46.9%) and non-STMI (38.1%). The prevalence of severe coronary lesions was 69.6% (95% CI 65.5 - 73.5). In multivariate analysis, the independent predictive factors of severe coronary lesions were male sex (odds ratio [OR] 2.00; p = 0.0141), diabetes (OR 1.92; p = 0.0070), left ventricular dysfunction (OR 1.81; p = 0.0059), age (OR 1.72; p = 0.0297) and no lipid-lowering treatment (OR, 0.47; p = 0.0388). Conclusions: Severe coronary lesions were present in two out three patients in this cohort of Algerian patients undergoing coronary angiography. Independent predictive factors of severe coronary lesions were male sex, diabetes, age, left ventricular dysfunction and no lipid-lowering treatment. It is important to identify these at-risk patients, as they should be explored at an asymptomatic stage before a cardiovascular event and receive prompt treatment with angioplasty or surgery.
References
[1]
Shao, C., Wang, J., Tian, J. and Tang, Y.D. (2020) Coronary Artery Disease: From Mechanism to Clinical Practice. In: Wang, M., Ed., Coronary Artery Disease: Therapeutics and Drug Discovery, Advances in Experimental Medicine and Biology, Vol. 1177, Springer, Berlin, 1-36. https://doi.org/10.1007/978-981-15-2517-9_1
[2]
INSP (2002) Mortalité générale. Projet TAHINA. Institut national de santé publique Alger, Algérie, 1-20.
[3]
Bauersachs, R., Zeymer, U., Briere, J.B., Marre, C., Bowrin, K. and Huelsebeck, M. (2019). Burden of Coronary Artery Disease and Peripheral Artery Disease: A Literature Review. Cardiovascular Therapeutics, 2019, Article ID: 8295054. https://doi.org/10.1155/2019/8295054
[4]
Friesinger, G.C., Page, E.E. and Ross, R.S. (1970) Prognostic Significance of Coronary Arteriography. Transactions of the Association of American Physicians, 83, 78-92.
[5]
Miller, R.R., DeMaria, A.N., Vismara, L.A., Salel, A.F., Maxwell, K.S., Armsterdam, E.A., et al. (1977) Chronic Stable Inferior Myocardial Infarction: Unsuspected Harbinger of High-Risk Proximal Left Coronary Arterial Obstruction Amenable to Surgical Revascularization. American Journal of Cardiology, 39, 954-960. https://doi.org/10.1016/S0002-9149(77)80207-5
[6]
Neeland, I.J., Patel, R.S., Eshtehardi, P., Dhawan, S., McDaniel, M.C., Rab, S.T., et al. (2012) Coronary Angiographic Scoring Systems: An Evaluation of Their Equivalence and Validity. American Heart Journal, 164, 547-552. https://doi.org/10.1016/j.ahj.2012.07.007
[7]
Diamond, G.A. and Forrester, J.S. (1979) Analysis of Probability as an Aid in the Clinical Diagnosis of Coronary-Artery Disease. The New England Journal of Medicine, 300, 1350-1358. https://doi.org/10.1056/NEJM197906143002402
[8]
Chaitman, B.R., Bourassa, M.G., Davis, K., Rogers, W.J., Tyras, D.H., Berger, R., et al. (1981) Angiographic Prevalence of High-Risk Coronary Artery Disease in Patient Subsets (CASS). Circulation, 64, 360-367. https://doi.org/10.1161/01.CIR.64.2.360
[9]
Proudfit, W.L., Shirey, E.K. and Sones, F.M. (1966) Selective Cine Coronary Arteriography. Correlation with Clinical Findings in 1000 Patients. Circulation, 33, 901-910. https://doi.org/10.1161/01.CIR.33.6.901
[10]
Mohagheghi, A., Mohebi, M., Hedayat, D.K., Tabatabaee, A. and Naseri, N. (2011) The Relationship of Gensini Score with the Cardiovascular Risk of Patients with Indication of Angiography. Tehran University Medical Journal, 69, 388-392.
[11]
Gensini, G.G. (1983) A More Meaningful Scoring System for Determining the Severity of Coronary Heart Disease. American Journal of Cardiology, 51, 606. https://doi.org/10.1016/S0002-9149(83)80105-2
[12]
Wilson, P.W., D’Agostino, R.B., Levy, D., Belanger, A.M., Silbershatz, H. and Kannel, W.B. (1998) Prediction of Coronary Heart Disease Using Risk Factor Categories. Circulation, 97, 1837-1847. https://doi.org/10.1161/01.CIR.97.18.1837
[13]
De Backer, G., Ambrosioni, E., Borch-Johnsen, K., Brotons, C., Cifkova, R., Dallongeville, J., et al. (2003) European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European Heart Journal, 24, 1601-1610. https://doi.org/10.1016/S0195-668X(03)00347-6
[14]
Chen, Z.W., Chen, Y.H., Qian, J.Y., Ma, J.Y. and Ge, J.B. (2014) Validation of a Novel Clinical Prediction Score for Severe Coronary Artery Diseases before Elective Coronary Angiography. PLOS ONE, 9, e94493. https://doi.org/10.1371/journal.pone.0094493
[15]
Khedr, L., Elasfar, A., Hekal, S., ElGendy, E., Abdulaal, M., Elsokkary, H., et al. (2018) Assessment of Left and Right Atrial Geometrical Changes in Patients with Stable Coronary Artery Disease: Left and Right Atrial Strain and Strain Rate Imaging Study. The Egyptian Heart Journal, 70, 101-106. https://doi.org/10.1016/j.ehj.2018.02.003
[16]
Charach, L., Blatt, A., Jonas, M., Teodorovitz, N., Haberman, D., Gendelman, G., et al. (2021) Using the Gensini Score to Estimate Severity of STEMI, NSTEMI, Unstable Angina, and Anginal Syndrome. Medicine (Baltimore), 100, e27331. https://doi.org/10.1097/MD.0000000000027331
[17]
Drissa, H., Zaouali, R., Meddeb, I., Kafsi, N., Abid, F. and Ismail, M.B. (1991) Diffusion des lésions coronaires et dépistage des atteintes tritronculaires dans l’infarctus postérieur. Médecine de Maghreb, 29, 35-40.
[18]
Raichlen, J.S., Healy, B., Achuff, S.C. and Pearson, T.A. (1986) Importance of Risk Factors in the Angiographic Progression of Coronary Artery Disease. American Journal of Cardiology, 57, 66-70. https://doi.org/10.1016/0002-9149(86)90953-7
[19]
Horimoto, M., Hasegawa, A., Ozaki, T., Takenaka, T., Igarashi, K. and Inoue, H. (2005) Independent Predictors of the Severity of Angiographic Coronary Atherosclerosis: The Lack of Association between Impaired Glucose Tolerance and Stenosis Severity. Atherosclerosis, 182, 113-119. https://doi.org/10.1016/j.atherosclerosis.2005.01.037
[20]
Koliaki, C., Sanidas, E., Dalianis, N., Panagiotakos, D., Papadopoulos, D., Votteas, V., et al. (2011) Relationship between Established Cardiovascular Risk Factors and Specific Coronary Angiographic Findings in a Large Cohort of Greek Catheterized Patients. Angiology, 62, 74-80. https://doi.org/10.1177/0003319710370960
