CORONARY-DISEASE WITH NORMAL CORONARY ANG IOGRAPHY IN THE BLACK-AFRICAN - A SERIES OF 31 CASES EPIDEMIOLOGIC AND CLINICAL-DATA ROLE OF THE HEMOGLOBINOPATHIES

The authors studied 31 cases of coronary artery disease with normal or minimally diseases coronary arteries in black Africans, 29.8 % of 104 coronary patients undergoing coronary angiography in this series. The se 31 cases comprised 16 cases of infarction, 10 cases of angina, 3 ve ntricular aneurysms and 2 cases of silent ischemia in diabetic patient s. Twenty-five patients were men (80.6 %). There were 6 women (19.3 %) two of whom presented in the post-partum period. The average age of t hese patients was 45 years (males: 47.7 years females : 41.8 years). T he following risk factors were noted: smoking (60 %), hypertension (25 .8 %), obesity (29 %), diabetes (12.9 %), serum cholesterol (average 2 .15 g/l), serum triglycerides (average 1.25 g/l). The risk index per p atient was 1.29. In comparison with coronary patients with angiographi c coronary lesions (n = 73), the patients with normal angiography were significantly younger, comprised more females and had fewer risk fact ors (especially hypertension and diabetes), though this was not statis tically significant. The prevalence of inaugural infarction was 81.2 % in the cases of infarction with normal coronary arteries. These infar cts may be complicated by ventricular aneurysm formation. Spontaneous spasm was observed in 3 out of 31 patients (9.6 %) at coronary angiogr aphy. A provocative test was performed in only 2 cases and 1 was posit ive. This deserves further study and may have therapeutic implications . The authors emphasise the high incidence of hemoglobin S or C traits (57.1 %). These heterozygotic hemoglobinopathies could be a risk fact or in these coronary patients with normal coronary angiography.