Angiographic phenotypes of coronary artery disease in an Afro-Caribbean cohort: a real-world catheterization laboratory analysis (2006–2024)

Background Angiographic phenotypes of coronary artery disease (CAD) in Afro-Caribbean populations remain poorly described, despite CAD’s major contribution to heart failure and overall mortality. Purpose To characterize angiographic phenotypes of coronary artery disease (CAD) and their clinical correlates in Afro-Caribbean patients undergoing coronary angiography, providing population-specific insights into anatomical patterns and clinical presentation. Methods We performed a single-center retrospective analysis of coronary angiography records from a high-volume tertiary cardiac catheterization laboratory (2006–2024). Using Python 3.11, we parsed structured and semi-structured reports to characterize coronary lesion patterns and generate descriptive statistics for demographics, coronary dominance, disease burden, stenosis severity, revascularization patterns, comorbidities, medications, and clinical measurements. Among a total patient population of 80,644, 2,410 patients underwent coronary angiography and were included in the final analysis. Results CAD was confirmed in 68.7% of angiograms, of which 68.5% were obstructive. Overall CAD prevalence in the total population was 1.93%. Mean age at first angiographic encounter was 61.2±12.2 years; 57.1% were male. Coronary dominance was right coronary artery (RCA) in 78.4%, left circumflex (LCx) in 13.8%, and codominant in 7.8%. Disease burden was single-vessel disease 23.9%, two-vessel disease 13.2%, and multivessel disease 8.1%. Left anterior descending (LAD)-predominant disease occurred in 34.9% of CAD cases, with mean stenosis severity of 75.3%±22.8%. Revascularization was performed in 42.9% of CAD patients (PCI 24.7%, CABG 2.8%). Hypertension (66.5%), dyslipidemia (42.3%), and diabetes (39.3%) were the most common comorbidities. Aspirin, statins, and beta-blockers were used in 57.6%, 56.9%, and 55.8% of CAD patients, respectively. Mean systolic blood pressure was 138.8±20.3 mmHg, diastolic blood pressure 80.4±11.4 mmHg, and body mass index 29.3±5.6 kg/m². Chronic total occlusion prevalence was 0.086% and spontaneous coronary artery dissection prevalence was 0.11%. Conclusion In this Afro-Caribbean angiography cohort, CAD was frequently obstructive and commonly LAD-predominant, with substantial multivessel burden and high cardiometabolic comorbidity prevalence. The high RCA dominance highlights population variation in coronary anatomy. These findings support population-specific cardiovascular risk stratification and may inform refinement of guideline implementation for Afro-Caribbean populations.