Figure 1
Map of Sub-Sahara Africa and Kenya.
Map of Sub-Sahara Africa and Kenya. The Aga Khan University Hospital is a private 300 bed referral Centre located in Nairobi, Kenya’s capital city, receiving patients from the Aga khan outreach clinics in East Africa and other hospital both private and public in the East African community, a conglomerate of 10 countries. It is equipped with various modalities of cardiac imaging; an echocardiography lab, CT coronary angiography, Cardiac MRI and ischemia testing. It has two operational catheterization laboratories and is accredited as a primary PCI Centre. It has a dedicated coronary care unit as well as a 5-day outpatient cardiac clinic for ambulatory patients. It serves a multiracial community.
Table 1
Baseline characteristics stratified by significant CAD status, N = 514.
| VARIABLE | OVERALL, N = 5141 | SIGNIFICANT CAD STATUS | P-VALUE2 | |
|---|---|---|---|---|
| WITHOUT SIGNIFICANT CAD, N = 2041 | WITH SIGNIFICANT CAD, N = 3101 | |||
| Age in years | 62.0(52.0, 71.0) | 57.0(49.0, 67.0) | 64.0(56.0, 72.0) | <0.001 |
| Gender | <0.001 | |||
| Males | 381/514(74.1%) | 134/204(65.7%) | 247/310(79.7%) | |
| Females | 133/514(25.9%) | 70/204(34.3%) | 63/310(20.3%) | |
| Race | <0.001 | |||
| Caucasian | 20/514(3.9%) | 4/204(2.0%) | 16/310(5.2%) | |
| African | 386/514(75.1%) | 184/204(90.2%) | 202/310(65.2%) | |
| Asian | 108/514(21.0%) | 16/204(7.8%) | 92/310(29.7%) | |
| height (cm) | 169.0(161.0, 175.5) | 168.0(161.0, 176.0) | 170.0(162.0, 175.0) | 0.46 |
| weight (Kg) | 78.0(69.0, 89.0) | 79.0(70.0, 89.2) | 78.0(66.6, 89.0) | 0.34 |
| BMI Kg/m2 | 27.1(24.5, 30.4) | 27.6(25.2, 31.0) | 26.7(24.1, 30.3) | 0.025 |
| Dwelling | <0.001 | |||
| Urban | 216/507(42.6%) | 64/202(31.7%) | 152/305(49.8%) | |
| Rural | 36/507(7.1%) | 20/202(9.9%) | 16/305(5.2%) | |
| Unknown | 255/507(50.3%) | 118/202(58.4%) | 137/305(44.9%) | |
| Lifestyle | 0.040 | |||
| Sedentary | 184/473(38.9%) | 75/188(39.9%) | 109/285(38.2%) | |
| Non-sedentary | 49/473(10.4%) | 27/188(14.4%) | 22/285(7.7%) | |
| Unknown | 240/473(50.7%) | 86/188(45.7%) | 154/285(54.0%) | |
| Alcohol intake | 69/439(15.7%) | 31/183(16.9%) | 38/256(14.8%) | 0.55 |
| NYHA Classification at first encounter | 0.035 | |||
| NYHA I | 36/500(7.2%) | 17/200(8.5%) | 19/300(6.3%) | |
| NYHA II | 294/500(58.8%) | 104/200(52.0%) | 190/300(63.3%) | |
| NYHA III | 104/500(20.8%) | 53/200(26.5%) | 51/300(17.0%) | |
| NYHA IV | 66/500(13.2%) | 26/200(13.0%) | 40/300(13.3%) | |
[i] 1 Median (IQR); n/N(%).
2 Wilcoxon rank sum test; Pearson’s Chi-squared test.
Table 2
Traditional risk factors stratified by significant CAD status, N = 514**.
| VARIABLE | OVERALL, N = 5141 | SIGNIFICANT CAD STATUS | P-VALUE2 | |
|---|---|---|---|---|
| WITHOUT SIGNIFICANT CAD, N = 2041 | WITH SIGNIFICANT CAD, N = 3101 | |||
| Systemic hypertension | 336/514(65.4%) | 134/204(65.7%) | 202/310(65.2%) | 0.90 |
| Diabetes mellitus | 242/514(47.1%) | 80/204(39.2%) | 162/310(52.3%) | 0.004 |
| Hypercholesterolemia | 65/514(12.6%) | 22/204(10.8%) | 43/310(13.9%) | 0.30 |
| Tobacco Smoking history | 71/514(13.8%) | 26/204(12.7%) | 45/310(14.5%) | 0.57 |
| Family history of CAD first degree relative < 65 years | 13/514(2.5%) | 3/204(1.5%) | 10/310(3.2%) | 0.21 |
| Age > 55 years women | 100/514(19.5%) | 49/204(24.0%) | 51/310(16.5%) | 0.034 |
| Age > 45 years men | 321/514(62.5%) | 106/204(52.0%) | 215/310(69.4%) | <0.001 |
| Low HDL < 1.0 mmol/l | 141/514(27.4%) | 48/204(23.5%) | 93/310(30.0%) | 0.11 |
| TGS > 5.17 mmol/l | 2/514(0.4%) | 0/204(0.0%) | 2/310(0.6%) | 0.52 |
| BMI > 25 kg/m2 | 281/514(54.7%) | 128/204(62.7%) | 153/310(49.4%) | 0.003 |
[i] 1 n/N(%).
2 Pearson’s Chi-squared test; Fisher’s exact test.
Table 3
2D Echocardiographic and MRI characteristics by CAD, N = 514**.
| VARIABLE | OVERALL, N = 5141 | SIGNIFICANT CAD STATUS | P-VALUE2 | |
|---|---|---|---|---|
| WITHOUT SIGNIFICANT CAD, N = 2041 | WITH SIGNIFICANT CAD, N = 3101 | |||
| LVEDD | 54.0(47.0, 59.0) | 56.0(49.0, 62.0) | 52.0(47.0, 58.0) | <0.001 |
| LVESD | 46.0(38.0, 52.0) | 48.0(40.0, 56.0) | 43.0(37.0, 50.0) | <0.001 |
| Modified biplane simpson’s rule LVEF | 30.0(20.0, 35.0) | 25.0(20.0, 35.0) | 33.0(25.0, 35.0) | <0.001 |
| LV mass index | 123.9(98.3, 153.1) | 129.2(102.8, 164.4) | 119.4(97.4, 143.2) | 0.042 |
| Regional Wall motion | 244/514(47.5%) | 36/204(17.6%) | 208/310(67.1%) | <0.001 |
| MRI | 46/494(9.3%) | 23/194(11.9%) | 23/300(7.7%) | 0.12 |
| MRI-LVEF | 35.0(26.0, 40.0) | 34.0(23.8, 39.0) | 35.0(26.0, 45.5) | 0.55 |
| MRI-RVEF | 47.0(34.5, 58.5) | 44.0(34.0, 48.0) | 57.0(38.0, 66.0) | 0.025 |
| MRI-LGE | 35/45(77.8%) | 13/22(59.1%) | 22/23(95.7%) | 0.004 |
| MRI-Ischaemic Cardiomyopathy | 25/45(55.6%) | 4/22(18.2%) | 21/23(91.3%) | <0.001 |
[i] 1 Median (IQR); n/N(%).
2 Wilcoxon rank sum test; Pearson’s Chi-squared test; Fisher’s exact test.
Table 4
Multivariable logistic regression model for patients with significant CAD.
| UNIVARIABLE | MULTIVARIABLE | ||||
|---|---|---|---|---|---|
| OR (95%CI) | P-VALUE | OR (95%CI) | P-VALUE | ||
| Gender | Males | 1 | |||
| Females | 0.49 (0.33–0.73) | <0.001 | 0.65 (0.29–1.49) | 0.311 | |
| Race | Caucasian | 1 | |||
| African | 0.27 (0.08–0.76) | 0.023 | 0.45 (0.10–1.71) | 0.267 | |
| Asian | 1.44 (0.38–4.55) | 0.559 | 1.60 (0.32–6.83) | 0.547 | |
| LVEF | 1.06 (1.04–1.08) | <0.001 | 1.02 (0.99–1.05) | 0.136 | |
| Current tobacco smoker | Yes | 3.41 (1.48–9.23) | 0.007 | 2.43 (0.86–7.70) | 0.108 |
| No | 1 | ||||
| DM | Yes | 1.70 (1.19–2.43) | 0.004 | 1.86 (1.15–3.03) | 0.011 |
| No | 1 | ||||
| Women: age > 55 years | Yes | 0.62 (0.40–0.97) | 0.035 | 1.36 (0.59–3.19) | 0.475 |
| No | 1 | ||||
| Men: age > 45 years | Yes | 2.09 (1.45–3.02) | <0.001 | 1.64 (0.81–3.35) | 0.168 |
| No | 1 | ||||
| BMI > 25 (Kg/m2) | Yes | 0.58 (0.40–0.83) | 0.003 | 0.48 (0.29–0.77) | 0.003 |
| No | 1 | ||||
| Q waves | Yes | 4.51 (2.74–7.77) | <0.001 | 2.12 (1.12–4.10) | 0.022 |
| No | 1 | ||||
| ST segment | Yes | 8.85 (5.32–15.52) | <0.001 | 4.14 (2.23–8.03) | <0.001 |
| No | 1 | ||||
| LBBB | Yes | 0.34 (0.20–0.57) | <0.001 | 1.20 (0.52–1.90) | 0.993 |
| No | 1 | ||||
| Regional Wall motion | Yes | 9.52 (6.25–14.81) | <0.001 | 6.53 (3.94–11.06) | <0.001 |
| No | 1 | ||||
Figure 2
The nomogram for the logistic regression for predictors of coronary artery disease.
LVEF-left ventricular ejection fraction, DM-diabetes Mellitus, LBBB- left bundle branch block, RWMA-regional wall motion abnormality. The location and length of each nomogram line illustrates its relative importance with respect to the risk of significant CAD. The sum of the predictors yields the “Total Score” which can be scaled to the final output probability of Significant CAD.