Key result
High-altitude residents with ACS had similar rates of isolated RCA (45.1%) and isolated LAD (44.0%) disease (difference 1.1%, P=0.840) and no full-cohort asymmetry (P=0.341).
Why the study?
Atherosclerotic coronary artery disease typically predominates in the left anterior descending artery, and whether this topographic distribution persists under chronic high-altitude hypobaric hypoxia remained uncertain.
Does chronic high-altitude hypobaric hypoxia (>3600 m) alter the angiographic topographic distribution of LAD versus RCA disease in Bolivian Andean residents with acute coronary syndrome?
Cohort (n=649)
Does chronic high-altitude hypobaric hypoxia (>3600 m) alter the angiographic topographic distribution of LAD versus RCA disease in Bolivian Andean residents with acute coronary syndrome?
Answers are grounded in this paper and cite their sources.
In high-altitude (>3600 m) Bolivian Andean residents presenting with acute coronary syndrome, isolated RCA and LAD disease occurred at similar frequencies without significant marginal asymmetry, generating hypotheses without warranting changes to standard clinical management.
Background Atherosclerotic coronary artery disease typically predominates in the left anterior descending artery (LAD). Whether this topographic distribution persists under chronic high-altitude hypobaric hypoxia remains uncertain. Objective To characterize angiographic coronary topography in high-altitude Bolivian Andean residents with acute coronary syndrome (ACS). Methods We retrospectively analyzed 649 permanent high-altitude residents (>3600 m, 1999–2024) undergoing coronary angiography for ACS. Significant disease was defined as >50% luminal stenosis. In a restricted cohort ( n = 441), the distribution of isolated LAD versus isolated right coronary artery (RCA) disease was evaluated using an exact two-sided binomial test. Paired marginal symmetry in the full cohort was evaluated via McNemar's test. Results In the full cohort, LAD involvement was present in 344 patients (53.0%) and RCA in 324 (49.9%). In the restricted cohort, RCA-only involvement occurred in 199 patients (45.1%), LAD-only in 194 (44.0%), and combined LAD+RCA in 48 (10.9%) (absolute difference 1.1%, P = 0.840). In the full cohort, paired discordance between LAD and RCA showed no significant marginal asymmetry (χ 2 = 0.905, P = 0.341). Conclusions Isolated RCA and LAD disease exhibited similar observed frequencies in this high-altitude cohort. These findings do not establish statistical equivalence, demonstrate RCA dominance, or warrant changes to guideline-directed clinical management. The results are descriptive and hypothesis-generating.
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Mamani et al. (2026) conducted a cohort in Acute coronary syndrome in high-altitude Bolivian Andean residents (n=649). Chronic high-altitude hypobaric hypoxia (>3600 m) was evaluated on Angiographic distribution of significant (>50% luminal stenosis) LAD versus RCA disease (Absolute difference 1.1%, p=0.840). High-altitude residents with ACS had similar rates of isolated RCA (45.1%) and isolated LAD (44.0%) disease (difference 1.1%, P=0.840) and no full-cohort asymmetry (P=0.341).
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