Clinical and Angiographic Profile of Acute Coronary Syndrome: Insights From a Tertiary Care Center in an Industrial Area

Background Acute coronary syndrome (ACS) patterns may be modified by environmental factors in industrial regions. This study examines the clinical and angiographic profile of ACS patients in a polluted industrial area of Eastern India. Methods We analyzed 213 consecutive ACS patients undergoing coronary angiography at a tertiary care center (April 2024-March 2025). Using RStudio, we performed descriptive statistics, comparative analyses (t-tests/Mann-Whitney U test for continuous variables; chi-square/Fisher's exact test for categorical variables), and multivariable logistic regression adjusting for age, sex, and hypertension. Effect sizes were calculated as odds ratios (OR) with 95% confidence intervals. Results The cohort (median age 58 years; 64.8% male) showed a high prevalence of dyslipidemia (119; 55.9%) and hypertension (103; 48.4%), with non-ST-elevation myocardial infarction (NSTEMI) being the most common presentation (86; 40.4%). Angiography revealed obstructive coronary artery disease (CAD) in 170 (79.8%) (predominantly LAD involvement: 85), non-obstructive CAD in 43 (20.2%), and slow-flow phenomenon in 61 (28.6%). Notably, spontaneous coronary artery dissection (SCAD) cases (11; 5.2%) showed an atypical 1:1 sex ratio. Patients with obstructive CAD were significantly older (median 62 vs 44 years, p<0.001) and demonstrated a paradoxical inverse association with diabetes (unadjusted OR 7.5, 95% CI 3.6-15.7, p<0.001). Conclusion This industrial cohort exhibited distinct ACS patterns, including high rates of microvascular dysfunction and atypical SCAD epidemiology, suggesting potential environmental influences on coronary pathophysiology that warrant further investigation.