Angiographic characteristics of premature coronary artery disease in Pakistani population; a prospective cross-sectional study

Objective: To study the angiographic characteristics of premature coronary artery disease in our population. Methodology: From April 2014 to March 2015, coronary angiograms of 102 patients less than 40 years of age with a definitive diagnosis of ischemic heart disease were studied. Traditional risk factors of atherosclerosis were documented. Mode of presentation and symptoms were recorded along with angiographic findings of coronary artery disease severity, degree of coronary involvement, culprit vessel, lesion morphology, coronary dominance, coronary ectasia and left ventricular systolic function. Results: Mean age was 36.4 +/- 4.1 years and 91% were male. Overall, left ventricular systolic function were fairly preserved (82%). 52% patients had single vessel CAD, 25% had double vessel while 19% had triple vessel coronary artery disease. Four patients had no luminal stenosis on coronary angiogram. LAD was the culprit vessel in 58.8%, RCA in 24.5% and left circumflex artery in 16.7% cases. More than 82% culprit lesions were severe or critical. 58% lesions were morphologically complex B2/ C type while only 42% lesions were type A/ B1. Coronary ectasia was seen in nearly 25% cases and all had ACS presentation. Right dominance was more common than left (57.8% vs 37.3%) while only 4.9% cases had dual posterior septal supply. Conclusion: Premature CAD in our population is acutely symptomatic, severe, complex (B2/ C), single vessel disease (primarily involving LAD artery) with fairly preserved left ventricular systolic function and there was an unheralded prevalence of coronary ectasia.