Coronary artery disease (CAD) is the leading cause of death worldwide in both men and women. Approximately 1 in 30 patients with stable CAD experiences cardiovascular death or myocardial infarction (MI) each year (1). It is the third leading cause of mortality worldwide and is associated with 17.8 million deaths annually. As well it places a large economic burden on the community (1–3). Moreover, there is little literature related to the epidemiology of CAD in Africa. Though, changes in lifestyle and modernization have risen the prevalence of CAD. Previous studies reported that the incidence of coronary artery disease (CAD) is rising by 160% in the Middle East and North Africa, and the mortality rate from CAD was high (120 per 100,000 populations) (4, 5). As in Tunisia, where studies have reported coronary artery disease (CAD) mortality rates increased by 11.8% for men and 23.8% for women, between 1997 and 2009, further causing the death of 70% of cardiovascular patients (6, 7). In addition, coronary artery disease has reached epidemic proportions in Egypt, the mortality rates due to CAD was measured to be 280 per 100,000 populations(8).
There are several risk factors for CAD, some can be controlled but not all. The non-modifiable risk factors are as follows; age, sex, race, family history, and/or physio-pathological conditions (9, 10).
Moreover, according to the 52 - country case-control study, nine easily measurable, controllable, and/or modifiable risk factors account for more than 90% of the heart diseases risk (11). These nine risk factors include smoking, abnormal blood lipid levels, high blood pressure, diabetes, obesity, a lack of physical activity, junk food, alcohol overconsumption, and the psychosocial index (11, 12). Among these cases, the most common form of cardiovascular disease, with an estimated prevalence of CAD in men than women (11). In additionally, several studies showed that modifiable classical risk factors for CAD, except for smoking, were more prevalent in women and were associated with their diet (13, 14).
In fact, there are three main strategies are available for angina control and prevention or reversal of plaque progression: medical treatment, Percutaneous coronary intervention PCI, and/ or Coronary artery bypass grafting CABG(15).
Percutaneous coronary intervention (PCI) is often part of standard therapy in patients presenting with significant coronary artery disease (CAD). In the same vein, in patients with stable CAD, PCI can be considered a valuable initial mode of revascularisation in all patients with objective large ischaemia in the presence of almost every lesion subset, with only one exception: chronic total occlusions that cannot be crossed (16).
Since 1977, when Grundzig performed the first PTCA in Zurich, percutaneous coronary intervention has been recognized as a leading procedure in treating coronary artery disease patients and has become a common part of routine practice worldwide (17).
Correspondingly, Coronary artery bypass grafting (CABG) is an acceptable procedure used to treat coronary artery disease, also management of refractory to medical treatment. Globally, there are around one million patients to undergo coronary artery bypass graft (CABG) surgery each year (18).
In Libya, there is rapid expansion and uptake of coronary angiography (C. Angio) procedure. However, when taking the entire clinical practice in Libya into consideration, limited data are available to describe nationwide contemporary practice patterns of C. Angio. Yet, until now, no unified nationwide registry has been established to demonstrate the accurate figures of cardiac procedures; Despite this, there has been a limited routine collection of related data particularly around quality, safety, and cost. With respect to the growing need for C. Angio, the development of C. Angio registries in Libya was of growing interest. As a clinical quality registry, a C. Angio database is an important mechanism of monitoring and benchmarking the performance of clinical care, improving safety and outcomes, contributing to reducing treatment costs, and regulating guidelines.
In this context, the objective of this study was to describe the characteristics and outcome of consecutive unselected Libyan patients who underwent diagnostic C. Angio in a nationwide cohort of one year. The present study is the first part of a study of coronary artery disease risk factors and causes in Libyan patients.