Coronary Angiographic Profile in Acute Coronary Syndrome: A Prospective Observational Study in Southern India

Document Type : Original Article

Authors

Department of General Medicine, Krishna Institute of Medical Sciences (Deemed-to-be) University, Karad, Maharashtra, India.

Abstract

Background:Coronary angiography performed during acute coronary syndrome (ACS) reveals different morphologies of the coronary artery such as occlusion, thrombosis, and stenosis. However, in some cases of ACS, angiography shows normal coronaries. Thus, we aimed to evaluate the pattern of coronary artery disease (CAD) in various cases of ACS using coronary angiography.
 
Methods:In this prospective study, 100 patients of either gender, aged above 18 years, with the chief complaint of typical chest pain and electrocardiographic abnormalities consistent with ACS, who underwent coronary angiography within 48 hours of admission were studied for angiographic patterns. Statistical analysis was performed using software R, version 3.6.0.
 
Results:The study population was comprised of 100 patients, of whom the majority were men (60%). The mean age was 56.86 ± 12.79 years. Most of the patients had unstable angina (39%), ST-elevation myocardial infarction (31%), and non–ST-elevation myocardial infarction (30%), followed by single-vessel disease (33%), double-vessel disease (19%), and triple-vessel disease (19%). The left anterior descending (LAD) was the most common artery involved (61%) with 31% of complex and diffuse lesions. Among patients with risk factors, including diabetes and hypertension, 41% had vessel occlusions. Statistically, no significant association was found between risk factors and angiographic findings (P = 0.193). A linear positive correlation was found between total cholesterol and the percentage of the vessel occlusion of an individual epicardial artery (LAD: 0.12r [P = 0.233], left circumflex: 0.104r [P = 0.302], and left main coronary artery: 0.016r [P = 0.869]).
 
Conclusions:Coronary angiography revealed a high incidence of multiple-vessel disease in our patients with hyperlipidemia, diabetes, and hypertension. However, it showed normal coronaries in a few patients with ACS. Therefore, coronary angiography may not always be useful in the detection of the etiology of myocardial ischemia in every patient. (Iranian Heart Journal 2021; 22(1): 42-48)

Keywords


 Emelia J. Benjamin, Paul Muntner, Alvaro Alonso, Marcio S. Bittencourt, Clifton W. Callaway, April P. Carson, et al. Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association. Circulation. 2019;139:e56–e528.  DOI: 10.1161/CIR.0000000000000659.
2. World Health Organization ‎. Global status report on noncommunicable diseases [Internet]. Geneva: World Health Organization; 2014. Available from: https://apps.who.int/iris/handle/10665/148114
Chadha SL, Radhakrishnan S, Ramachandran K, Kaul U, Gopinath N. Epidemiological study of coronary heart disease in urban population of Delhi. Indian J Med Res. 1990;92:424-30.
Deedwania P, Singh V. Coronary artery disease in South Asians: evolving strategies for treatment and prevention. Indian Heart J. 2005;57:617-31.
Gupta R, Gupta VP. Meta-analysis of coronary heart disease prevalence in India. Indian Heart J. 1996;48:241-5.
Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342:1163-70. DOI: 10.1056/NEJM200004203421603.
Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): A prospective analysis of registry data. Lancet. 2008;371:1435-42. DOI:10.1016/S0140-6736(08)60623-6.
Ranjith N, Pegoraro RJ, Zaahl MG. Risk Factors Associated with Acute Coronary Syndromes in South African Asian Indian Patients [The AIR Study]. J Clinic Experiment Cardiol. 2011;2:163. DOI:10.4172/2155-9880.1000163.
Wadkar A, Sathe A, Bohara D, Shah H, Mahajan A, Nathani P. Clinical & angiographic profile of young patients (<40 yrs) with acute coronary syndrome.                 J Ind Coll Cardiol. 2014;4:95-100. DOI: 10.1016/j.jicc.2014.02.009.
Tewari S, Kumar S, Kapoor A, Singh U, Agarwal A, Bharti BB et al. Premature coronary artery disease in North India: An angiography study of 1971 patients. Indian Heart J. 2005;57:311-8.
Hughes LO, Wojciechowski AP, Raftery EB. Relationship between plasma cholesterol and coronary artery disease in Asians. Atherosclerosis. 1990;83:15-20. DOI: 10.1016/0021-9150(90)90125-3.
Kumar N, Sharma S, Mohan B, Beri A, Aslam N, Sood N, Wander GS. Clinical and angiographic profile of patients presenting with first acute myocardial infarction in a tertiary care centre in Northern India. Indian Heart J. 2008;60:210-14. DOI: 10.1016/j.ihj.2019.12.004.
Mohammad AM, Sheikho SK, Tayib JM. Relation of cardiovascular risk factors with coronary angiographic findings in Iraqi patients with ischemic heart disease. Am J Cardiovasc Dis Res. 2013;1:25-9. DOI:10.12691/ajcdr-1-1-6.