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Angiographic Characteristics of Coronary Artery Disease in Patients with Systolic Heart Failure: A Sub-Saharan
Ishak Ahmed Abdi1, Mesut Karataş1,2, Can Baba Arin1,3
1Department of Cardiology, Mogadishu Somali Türkiye Training and Research Hospital, Mogadishu, Somalia.
Insights
Severe coronary artery disease (CAD) is prevalent in Somali heart failure (HF) patients, linked to diabetes and smoking. Early screening and risk factor management are crucial for improving HF outcomes in the region.
Area of Science:
- Cardiology
- Public Health
- Medical Research
Background:
- Heart failure (HF) presents a growing challenge in Sub-Saharan Africa.
- Coronary artery disease (CAD) is increasingly recognized as a primary driver of HF in this region.
- Limited angiographic data exists for HF patients in Sub-Saharan Africa.
Purpose of the Study:
- To investigate the prevalence and predictors of severe CAD in heart failure patients in Somalia.
- To provide crucial angiographic data from a region with scarce information.
- To inform screening strategies and resource allocation for HF management.
Main Methods:
- Retrospective analysis of 169 heart failure patients undergoing coronary angiography.
- Classification of CAD severity based on stenosis.
- Analysis of demographic, clinical, and echocardiographic data.
- Logistic regression to identify predictors of severe CAD.
Main Results:
- Coronary artery disease (CAD) was identified in 53.3% of heart failure (HF) patients, with 23.1% having severe CAD.
- Independent predictors for severe CAD included diabetes (OR=7.44) and smoking (OR=2.61).
- Patients with severe CAD exhibited lower ejection fractions and higher SYNTAX scores.
Conclusions:
- Severe CAD is a significant finding in Somali HF patients, strongly associated with diabetes and smoking.
- Prioritizing systematic ischemic evaluation and aggressive risk factor control is recommended.
- This study offers foundational angiographic data to guide clinical practice and future research in the region.
Background:
Heart failure (HF) is an increasing burden in Sub-Saharan Africa, with coronary artery disease (CAD) emerging as a major cause. However, angiographic data in HF patients remain scarce in this region.
Methods:
This retrospective study included 169 HF patients who underwent coronary angiography between 2023 and 2025 at Mogadishu Somali Türkiye Training and Research Hospital. CAD severity was classified as minor, moderate, or severe (≥70% stenosis in epicardial arteries or ≥50% in the left main). Demographic, clinical, and echocardiographic data were analyzed. Logistic regression identified predictors of severe CAD.
Results:
The mean age was 54.3 ± 10.9 years, and 33.1% were male. CAD was present in 53.3% of patients, with severe CAD in 23.1%. Single-vessel disease was most frequent, followed by double-vessel, triple-vessel, and left main involvement. Based on SYNTAX scoring, 27.2% had low, 10.1% intermediate, and 6.5% high scores, indicating a subset with complex anatomy. On univariate analysis, diabetes (P < 0.001), dyslipidemia (P < 0.001), smoking (P = 0.03), and khat chewing (P = 0.03) were significantly associated with severe CAD. Patients with severe CAD also had lower ejection fraction (26.3% vs 29.8%, P = 0.01) and higher SYNTAX scores (34.7 vs 19.6, P < 0.001). In multivariate analysis, diabetes (OR = 7.44, 95% CI: 3.04-18.17, P < 0.001) and smoking (OR = 2.61, 95% CI: 1.10-6.23, P = 0.03) remained independent predictors.
Conclusion:
Severe CAD is common among HF patients in Somalia and is strongly associated with diabetes and smoking. Systematic ischemic evaluation and aggressive risk factor control should be prioritized to improve outcomes. This study provides one of the first angiographic datasets from the region, offering evidence to guide screening, optimize scarce diagnostic resources, and inform future multicenter research.
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