Angiographic Characteristics of Coronary Artery Disease in Patients with Systolic Heart Failure: A Sub-Saharan Referral Center Experience

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.