Angiographic Prevalence of Obstructive Coronary Artery Disease at the Colonial War Memorial Hospital from June 2009 to May 2014

Introduction:
The angiographic prevalence of Obstructive Coronary Artery Disease (OCAD) in Fiji is not known. The angiographic prevalence of OCAD at CWM Hospital Cardiac Catheterization Laboratory would reflect on the burden of disease on the health sector, assess the diagnostic yield of referral strategy and effectiveness of non invasive testing. The study also aims to determine the predictors of obstructive coronary artery disease. Furthermore, the proportion of Single vessel (SVD), Double Vessel(DVD) and Triple Vessel (TVD)Coronary Artery Disease can be obtained .
Method: A descriptive, unicenter, retrospective record review of patients undergoing invasive coronary angiogram from June 2009 to May 2014 at CWM Hospital Cardiac Catheterization Laboratory. Out of 708 patients, 463 cases were analyzed.
Results: The angiographic prevalence of OCAD at the CWM Hospital Cardiac Catheterization Lab is 82.5% from June 2009 to May 2014. Out of the OCAD cases, the proportion of SVD is 23%,DVD 22% and TVD 55%. The angiographic prevalence of significant Left main coronary Artery Disease is 11%. The clinical predictors for OCAD are Diabetes Mellitus Type 2 OR=2 .18, (95 % CI1.31-3.62) ,p=O.003, Hypertension OR== 1.791 (95 % CI1.09-2.9) p=0.026,Current Smoking OR 3.85 (95 % CI1.96-7.52)p=0.00006, Dyslipidemia OR ==2.71 (95 % CI1.64­-4.47) p=O.OOOl, Family History of CAD, OR=2.01 (95 % CI1.23-3.26) p=0.006 and the presence of definite angina on history OR 4.78 (95 % CI 2.52-9.04) p<O.OOl. The non-invasive predictors of OCAD are a positive EST with OR=3.31 (95% CI1.16-9.40), p=0.04 and presence of Regional Wall Motion Abnormality( RWMA) on Resting Echocardiogram, OR=3.96, (95% CI 2.02-7.74), p=0.00005. The risk of complication from invasive coronary angiogram is 0.86% per procedure.
Discussion: The angiographic prevalence of OCAD at the CWM Hospital Cardiac Catheterization Lab is significantly high with a high proportion of TVD and high prevalence of Left Main CAD. Fiji needs a regulary running coronary angiogram service and plan for establishment of cardiothoracic services in future to provide Coronary Artery Bypass Grafting( CABG).