Clinical and Angiographic Differences in Urban vs. Rural Patients with Acute Coronary Syndrome Undergoing Angiography: Insights from a Low-Resource Setting in Pakistan

Abstract

Background: Acute coronary syndrome remains a major cause of cardiovascular morbidity and mortality in low- and middle-income countries, where differences in cardiometabolic risk exposure and access to specialist care may shape clinical presentation and outcomes. Urban-rural disparities in these domains remain insufficiently characterized in low-resource regions of Pakistan. Objective: To compare the clinical characteristics, cardiovascular risk profile, angiographic findings, and management patterns of urban and rural patients with acute coronary syndrome undergoing coronary angiography at a tertiary care hospital in Quetta, Pakistan. Methods: This hospital-based descriptive comparative cross-sectional study included 125 adult patients with acute coronary syndrome who underwent coronary angiography. Patients were categorized as urban or rural according to place of residence. Demographic features, cardiovascular risk factors, clinical presentation, angiographic characteristics, and management patterns were descriptively compared between the two groups. Results: Approximately 94 patients (75.2%) were from urban areas and 31 (24.8%) were from rural areas. Male patients predominated in both groups, while urban patients were relatively younger. Hypertension was the most common cardiovascular risk factor overall, followed by diabetes mellitus and smoking, and these factors were more frequently observed in urban patients. Urban patients also more commonly exhibited multivessel coronary artery disease, whereas rural patients more often showed delayed presentation, greater clinical severity at admission, lower access to primary percutaneous coronary intervention and coronary artery bypass grafting, and slightly higher in-hospital mortality. The left anterior descending artery was the most commonly involved vessel in both groups. Conclusion: Urban patients demonstrated a greater burden of conventional cardiovascular risk factors and angiographic disease, whereas rural patients experienced later presentation and poorer access to timely specialist cardiac care, highlighting dual dimensions of disparity in acute coronary syndrome management in low-resource settings.