Percutaneous Balloon Angioplasty (POBA) was once the primary coronary intervention before the advent of stent technology. However, in low-income populations where affordability, availability, and access to advanced interventional care remain limited, POBA is still considered a viable and cost-effective first-line approach. This study evaluates the clinical effectiveness, complication rates, and post-procedural outcomes of POBA in economically disadvantaged patients with coronary artery disease (CAD). A cohort of 412 low-income patients undergoing PCI without stent placement was observed over 18 months. Results show that while POBA had higher restenosis rates (28.4%) compared to historical drug-eluting stent (DES) outcomes, immediate symptom relief (92%), reduced procedural costs (73% lower), and lower hospitalization expenses made it an accessible first-line therapy. The findings suggest POBA remains clinically relevant in resource-limited settings, particularly when supported by long-term pharmacotherapy and follow-up.