A BSTRACT Introduction: The effects of high-altitude area (HAA) on humans are considerable, and among the various environmental risk factors, HAA is one which contributes to the incidence and prevalence of coronary artery disease. To date, no guidelines concerning cardiac disease and high altitude are available. This study aimed to compare the echocardiography (ECHO), coronary angiography (CAG), and management outcomes in patients of acute coronary syndrome (ACS) from HAA and those residing in plains. Methods: One-hundred fifty patients of ACS from HAA and plains, admitted with diagnosis of ACS, were included in the study. Data on ECHO, CAG, and management outcomes of consecutive patients from HAA and plains were analyzed to assess whether high altitude itself predisposes to ACSs. Results: In this study, the majority of patients were males (97.3%). ST elevation was seen in 66.7% and 72% from HAA and plains, respectively. Thrombolysis was conducted in 46.7% and 12% of patients, respectively, from HAA and plains. A significantly higher proportion of regional wall motion abnormalities (RWMA) (50.7%) were present in patients from high altitude. Patients from HAA had low ejection fraction as compared to plains. All subjects underwent CAG, and the majority were managed with percutaneous transluminal coronary angioplasty (PTCA) followed by plain old balloon angioplasty (POBA) and primary angioplasty in myocardial infarction (PAMI). A greater number of patients from HAA had recanalized arteries which were managed with low-molecular-weight heparin (LMWH), and in plains, mostly stenosed arteries were found. A slow flow in the coronary artery was observed in high-altitude patients (30.7%) as compared to sea level (14.7%). The prevalence of double vessel disease (DVD) and triple vessel disease (TVD) was found to be higher in patients from plain areas. Conclusion: In our study, we found that ACS patients from HAA have less complex coronary lesions with higher rate of thrombolysis, recanalized coronaries, and slow flow, whereas ACS patients from plains have more complex coronary lesions with higher PTCA rate. Also, we conclude that HAA may itself be responsible for the development and aggravation of coronary artery disease. As the literature regarding the comparison of coronary events among high and low altitudes is sparse, more studies need to be conducted.
Rai et al. (Mon,) studied this question.