Objective: To define the impact of the cardiovascular risk factors on the extent of Coronary Artery Disease and to identify the common prevalent risk factors and that are unrecognized or poorly treated resulting in STEMI among the UAE population.
Methods: Retrospective Cohort Study conducted on all patients (n=104) presented to our Hospital during the study period (01/01/11 - 31/12/16) with signs and symptoms of ACS and underwent emergency Primary Percutaneous Coronary Intervention (PCI) for confirmed ST Elevation Myocardial Infarction (STEMI).
Results: Of the 104 STEMI patients,91% were males and 80% were expatriates. Age: Mean +SD of 53 +12.5 years.73% were less than 60 years old.Hypertension(42%), Smoking and Dyslipidemia(37% each),Positive Family History of CAD(29%),Obesity(28%) and Diabetes(26%).BMI >25(85%),48% had features of Metabolic Syndrome.80% had Low HDL.38% of diabetics had an HbA1C of > 7%. 14% of the dyslipidemic had above target lipid levels in spite of Statin.100% of the study population had at least 1 risk factor,97% had >2,82% >3,48% had >4 and 28% had >5 risk factors.50% had 1 or more incidental risk factors diagnosed after admission.The most common incidental risk factors were dyslipidemia(36%),diabetes(30%) and hypertension(16%).The total risk factor counts multiplied when the incidental or poorly treated risk factors were added to the initial risk factors on admission (number of patients who had 5 or more risk factors were tripled from 29 to 82).Anterior Wall STEMI(38%),Inferior Wall(29%). Left Anterior Descending(48%) was the commonest culprit vessel, Right Coronary(27%) and Left Circumflex(20%). 5% had 2 culprit vessels. Triple Vessel Disease(37%),followed by Single Vessel(32%) and Two Vessel Disease(31%). 37% developed in-hospital complication,of which the commonest was Acute Pulmonary Edema(23.7%).The prevalence of majority of the risk factors is higher in multi vessel disease than in single vessel disease, however the association between the risk factors and disease severity was not statistically significant.The odds of multi vessel disease increased with cumulative risk factor categories, but there was no significant trend association.
Conclusion: No statistical difference in risk factor prevalence was seen between single vessel and multi vessel disease. The study did not show strong evidence linking risk factors to multi vessel disease. The study did prove clinical significance of incidental or under diagnosed or poorly treated risk factors and its impact on the severity of CAD. This gives an opportunity to stress the importance of every single risk factor to be dealt with equal importance.