European Journal of Cardiovascular Medicine

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide. Among these, ischemic heart disease (IHD), often resulting from coronary artery disease (CAD), constitutes a major public health burden affecting millions globally. Coronary artery disease is characterized by atherosclerotic plaque accumulation within the coronary arteries, leading to impaired myocardial perfusion, ischemia, and potentially infarction. The clinical manifestations of CAD range from stable angina to acute coronary syndromes, including unstable angina, myocardial infarction, and sudden cardiac death.^[1]

The diagnosis and management of CAD have evolved significantly over recent decades. Coronary angiography (CAG), an invasive imaging technique, remains the gold standard for visualizing the coronary anatomy and defining the extent and severity of coronary artery lesions. It provides vital anatomical information that guides therapeutic decision-making. Percutaneous transluminal coronary angioplasty (PTCA), introduced in the late 1970s, revolutionized the treatment of CAD by allowing mechanical revascularization of stenosed coronary arteries via catheter-based balloon dilation, often accompanied by stent implantation. PTCA has become a cornerstone in the management of both stable and acute coronary syndromes, offering improved symptom relief, myocardial salvage, and survival benefits.^[2]

Understanding the epidemiological and clinical characteristics of patients undergoing CAG and PTCA is essential for optimizing cardiovascular care. These profiles help delineate disease patterns, risk factor prevalence, procedural indications, and outcomes. Such data also aid in resource allocation, guideline formulation, and identifying subgroups requiring targeted interventions.^[3]

Multiple studies globally have demonstrated variations in the prevalence of CAD and related interventions based on demographic factors such as age, sex, socioeconomic status, and comorbid conditions including diabetes mellitus, hypertension, and chronic kidney disease. For example, men tend to present with CAD at younger ages compared to women, while diabetic patients often exhibit more diffuse and severe coronary involvement. These comorbidities influence both the clinical presentation and procedural outcomes, making comprehensive profiling crucial.^[4]

Additionally, advancements in interventional cardiology, such as drug-eluting stents, intravascular imaging, and improved pharmacotherapy, have altered the landscape of coronary interventions. However, challenges persist, including restenosis, stent thrombosis, and procedural complications. Hence, clinical profiling of patients undergoing PTCA remains vital for risk stratification and prognostication.^[5]

Regional epidemiological data are particularly important due to geographical and population-specific variations in CAD prevalence and healthcare access. In India, CAD prevalence is increasing rapidly, attributed to urbanization, lifestyle changes, and rising incidence of metabolic risk factors. Yet, comprehensive data on the demographic and clinical characteristics of patients undergoing coronary interventions in many parts of the country remain sparse.^[6]

Aim

To study the epidemiological and clinical profile of patients undergoing coronary angiography and percutaneous transluminal coronary angioplasty.

Objectives

1. To analyze the demographic characteristics and risk factor profile of patients undergoing coronary angiography and PTCA.
2. To assess the clinical indications, angiographic findings, and extent of coronary artery disease in these patients.
3. To evaluate the procedural details and immediate clinical outcomes of patients undergoing PTCA.

Source of Data

The data for this study were collected retrospectively from the medical records of patients who underwent coronary angiography and percutaneous transluminal coronary angioplasty at the Department of Cardiology. The hospital maintains a digital registry of all cardiac catheterization procedures which was utilized for data extraction. Patient demographics, clinical presentation, angiographic findings, procedural details, and relevant laboratory parameters were reviewed.

Study Design

This was a retrospective observational cross-sectional study analyzing epidemiological and clinical characteristics of patients undergoing coronary angiography and PTCA.

Study Location

The study was conducted at the Department of Cardiology.

Study Duration

Data were collected for a period of three years, from January 2021 to December 2023.

Sample Size

The total sample size included 847 patients who underwent coronary angiography and/or PTCA during the study period and met the inclusion criteria.

Inclusion Criteria

• Patients aged ≥18 years who underwent diagnostic coronary angiography for suspected or established coronary artery disease.
• Patients who underwent PTCA with or without stent placement as a therapeutic intervention during the study period.
• Both elective and emergency cases were included.

Exclusion Criteria

• Patients with incomplete medical records or missing key clinical data.
• Patients undergoing coronary angiography for congenital heart diseases or structural cardiac interventions other than CAD.
• Patients who had prior coronary artery bypass graft surgery.
• Patients who refused consent for use of their medical data for research purposes.

Procedure and Methodology

All patients underwent coronary angiography using standard femoral or radial arterial access according to institutional protocols. Angiographic images were analyzed by experienced interventional cardiologists. The extent of coronary artery disease was classified based on the number of vessels involved — single vessel disease (SVD), double vessel disease (DVD), and triple vessel disease (TVD). Lesions were further characterized by location (left anterior descending artery [LAD], right coronary artery [RCA], left circumflex artery [LCX]) and severity.

Indications for PTCA included critical coronary stenosis (>70% luminal narrowing), acute coronary syndrome (unstable angina, NSTEMI, STEMI), and refractory angina despite medical therapy. PTCA was performed using balloon angioplasty and deployment of bare-metal or drug-eluting stents as appropriate.

Periprocedural antiplatelet therapy and anticoagulation were administered following standard guidelines. Procedural success, complications, and immediate outcomes were documented.

Sample Processing

Data extracted from the digital registry and patient records were anonymized and entered into a structured proforma including demographics, clinical presentation, risk factors (diabetes, hypertension, smoking), laboratory investigations (lipid profile, blood glucose), angiographic findings, and procedural details.

Statistical Methods

Data analysis was performed using statistical software SPSS version 25. Continuous variables were expressed as mean ± standard deviation (SD), and categorical variables as frequencies and percentages. Comparison between groups was conducted using chi-square tests for categorical variables and Student’s t-test or ANOVA for continuous variables as appropriate. A p-value of <0.05 was considered statistically significant.

Data Collection

Data were collected retrospectively by reviewing hospital records, catheterization laboratory logs, and electronic health records. Demographic data including age, sex, and comorbidities were recorded. Clinical presentation was categorized as stable angina, unstable angina, NSTEMI, STEMI, or other indications. Angiographic and procedural details including vessel involvement, lesion characteristics, PTCA technique, and immediate outcomes were documented in a standardized format.

Table 1: Demographic and Clinical Characteristics (n=847)

*Notes: SVD=Single Vessel Disease, DVD=Double Vessel Disease, TVD=Triple Vessel Disease, Other = non-specific IHD or CAD without vessel detail, PTCA=Percutaneous Transluminal Coronary Angioplasty

The study included 847 patients undergoing coronary angiography and percutaneous transluminal coronary angioplasty (PTCA). The age distribution showed that the majority of patients were between 51 to 70 years, with 25.6% aged 51–60 years and 23.7% aged 61–70 years, while a smaller proportion, 3.2%, were younger than 30 years. This age distribution was statistically significant (χ² = 48.73, p < 0.001), highlighting a predominance of middle-aged to elderly patients presenting for coronary interventions. Males constituted a significantly larger proportion (74.7%) compared to females (25.3%) (χ² = 89.21, p < 0.001), consistent with known gender differences in coronary artery disease prevalence. Regarding diagnosis, double vessel disease (DVD) was the most frequent finding (27.4%), followed by Other non-specific or unclassified coronary conditions (42.8%), single vessel disease (SVD) at 16.3%, and triple vessel disease (TVD) at 13.5%. The distribution of vessel involvement was significant (χ² = 52.47, p < 0.001). PTCA was performed in 62.1% of patients, with 37.9% not undergoing the procedure; this difference was also statistically significant (χ² = 44.18, p < 0.001).

Table 2: Demographic Characteristics and Risk Factor Profile (n=847)

Analysis of risk factors in the 847 patients revealed hypertension in 43.9% and diabetes mellitus in 35.2%, both significantly associated with coronary artery disease (HTN: χ² = 18.56, p < 0.001; DM: χ² = 22.11, p < 0.001). Smoking was prevalent in 36.9% of the cohort, a significant finding (χ² = 9.74, p = 0.002), confirming its role as a major modifiable risk factor. The mean body mass index (BMI) was 26.8 ± 4.3 kg/m², with statistical analysis showing a significant difference (t = 2.87, 95% CI 0.6 to 1.8, p = 0.004), suggestive of overweight status contributing to cardiovascular risk. Family history of coronary artery disease was positive in 23.4% of patients, also statistically significant (χ² = 5.29, p = 0.021).

Table 3: Clinical Indications, Angiographic Findings, Extent of Disease (n=847)

The predominant clinical indication for coronary angiography was stable angina, comprising 40.6% of cases, followed by unstable angina (26.8%), NSTEMI (17.1%), and STEMI (15.5%), with a highly significant overall distribution (χ² = 45.27, p < 0.001). Angiographic analysis demonstrated double vessel disease in 27.2% of patients, single vessel disease in 16.5%, triple vessel disease in 13.6%, and 42.7% had normal or non-significant coronary lesions (χ² = 34.87, p < 0.001). Lesions were most commonly located in the left anterior descending artery (LAD) at 47.1%, followed by the right coronary artery (RCA) at 36.8%, and left circumflex artery (LCX) at 30.7%, also showing significant differences (χ² = 29.14, p < 0.001). The mean left ventricular ejection fraction (LVEF) was 48.5% ± 7.9, with significant variation noted (t = 3.22, p = 0.001).

Table 4: Procedural Details and Immediate Clinical Outcomes (n=847)

Among the 847 patients, 62.1% underwent PTCA, while 37.9% did not, with this procedural distribution reaching statistical significance (χ² = 37.65, p < 0.001). Drug-eluting stents were used in the majority of cases (78.3%), significantly more than bare-metal stents (21.7%) (χ² = 11.24, p = 0.001). Procedural success was high, with 94.1% of PTCA procedures being successful (χ² = 5.39, p = 0.020). Complications were relatively low but present in 8.9% of patients, a significant finding (χ² = 7.83, p = 0.005). The mean hospital stay was 4.6 ± 1.8 days, with significant variation observed (t = 2.68, 95% CI 0.4 to 1.3, p = 0.008). In-hospital mortality was low at 2.3%, but statistically significant (χ² = 3.98, p = 0.046).

Table 1: Demographic and Clinical Characteristics The demographic profile of our cohort (n=847) showed a predominance of middle-aged and elderly patients, with the majority aged between 51 and 70 years, consistent with established epidemiological data that CAD incidence increases with age due to progressive atherosclerosis and cumulative risk exposure Sanghvi S et al.(2018)^[7]. The gender distribution revealed a significant male predominance (74.7%), aligning with global trends where men have earlier and higher rates of CAD compared to women, attributed to hormonal, behavioral, and genetic factors Setty HN et al.(2016)^[8]. The diagnosis pattern demonstrated a higher frequency of double vessel disease (27.4%) and a substantial proportion classified as Other, which may include non-obstructive CAD or mixed pathology. Comparable studies by Yadav et al. and Gupta et al. also report DVD and TVD as common angiographic patterns in symptomatic patients undergoing catheterization de Araújo RB et al.(2020)^[9]. PTCA was performed in 62.1% of patients, reflecting contemporary practice trends where revascularization is guided by lesion severity and clinical status, consistent with the data from the large-scale INTERHEART study and regional registries Ahmed R et al.(2019)^[10].

Table 2: Demographic Characteristics and Risk Factor Profile Hypertension (43.9%) and diabetes mellitus (35.2%) were prevalent comorbidities, corroborating their role as dominant modifiable risk factors in CAD pathogenesis worldwide. This mirrors findings from several Indian cohorts highlighting the high burden of these metabolic risk factors in patients presenting with ischemic heart disease Kumar V et al.(2021)^[11]. Smoking was reported in 36.9% of patients, a significant contributor to endothelial dysfunction and plaque progression. The mean BMI of 26.8 kg/m² indicates an overweight population, consistent with urbanization-related lifestyle changes observed in developing countries. A positive family history of CAD in 23.4% supports the genetic predisposition in CAD, as similarly documented in previous studies Thoke SV et al.(2023)^[12]. These findings emphasize the multifactorial etiology of CAD and the necessity for comprehensive risk factor management in clinical practice.

Table 3: Clinical Indications, Angiographic Findings, and Extent of Disease Stable angina was the most common clinical presentation (40.6%), followed by acute coronary syndromes (unstable angina, NSTEMI, STEMI). This distribution aligns with large registry data where chronic stable angina remains a frequent indication for angiography, yet acute syndromes contribute substantially to the interventional workload Kadam VK.(2019)^[13]. Vessel involvement showed a predominance of DVD (27.2%) and a considerable proportion (42.7%) of patients with normal or non-significant coronary lesions, which might represent microvascular angina or early CAD. The high incidence of LAD involvement (47.1%) confirms the critical role of this artery in myocardial perfusion and risk stratification, consistent with other angiographic studies Parikh RP et al.(2019)[14]. The mean LVEF of 48.5% reflects a wide range of cardiac function in this cohort, highlighting the importance of echocardiographic assessment in prognostication and procedural planning Chhabra ST et al.(2018)^[15].

Table 4: Procedural Details and Immediate Clinical Outcomes PTCA was performed in 62.1% of patients, with drug-eluting stents (DES) being the predominant device (78.3%), reflecting current guideline recommendations favoring DES due to reduced restenosis rates Ravi PG et al.(2015)^[16]. The procedural success rate of 94.1% is comparable to international benchmarks and underscores advances in interventional cardiology techniques and devices. Complications occurred in 8.9% of cases, including vascular and procedural adverse events, which is consistent with reported complication rates ranging between 5-10% in similar populations Kaur M et al.(2023)^[17]. The mean hospital stay of 4.6 days is reflective of a typical post-PTCA observation period in tertiary care settings. In-hospital mortality was low (2.3%) but statistically significant, aligning with published literature that reports early mortality rates of 1-3% in PCI cohorts, emphasizing the inherent risks especially in complex or unstable presentations Jayaram AA et al.(2015)^[18].

his study provides a comprehensive overview of the epidemiological and clinical characteristics of patients undergoing coronary angiography and percutaneous transluminal coronary angioplasty (PTCA). The findings reveal a predominance of middle-aged and elderly male patients with a high prevalence of traditional cardiovascular risk factors such as hypertension, diabetes mellitus, and smoking. Stable angina was the most common clinical presentation, with double vessel disease being the most frequent angiographic pattern. The left anterior descending artery was the most commonly involved vessel. PTCA was performed in a majority of cases, predominantly using drug-eluting stents, with a high procedural success rate and acceptable complication profile. These results align with global and regional data, highlighting the burden of coronary artery disease and the critical role of interventional cardiology in management. The study underscores the need for aggressive risk factor modification and early detection strategies to reduce the burden of ischemic heart disease in this population.

LIMITATIONS OF THE STUDY

Several limitations should be acknowledged. First, the retrospective and single-center nature of the study may limit the generalizability of the findings to broader populations. Second, data on long-term clinical outcomes, including restenosis rates, recurrent ischemic events, and mortality, were not available, restricting assessment of the durability of interventions. Third, some clinical and risk factor data were obtained from medical records and patient self-report, potentially introducing reporting bias. Fourth, the Other category in diagnosis encompassed heterogeneous conditions without detailed subclassification, which may affect the precision of angiographic characterization. Lastly, procedural decisions including stent type and PTCA performance were at the discretion of the treating physician, introducing potential selection bias.

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