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

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: 0.12(r) [P = 0.233], left circumflex: 0.104(r) [P = 0.302], and left main coronary artery: 0.016(r) [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.