Acute Coronary Syndromes in Sub-Saharan Africa: A 10-Year Systematic Review.

Background Data in the literature on acute coronary syndrome in sub-Saharan Africa are scarce. Methods and Results We conducted a systematic review of the MEDLINE (PubMed) database of observational studies of acute coronary syndrome in sub-Saharan Africa from January 1, 2010 to June 30, 2020. Acute coronary syndrome was defined according to current definitions. Abstracts and then the full texts of the selected articles were independently screened by 2 blinded investigators. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. We identified 784 articles with our research strategy, and 27 were taken into account for the final analysis. Ten studies report a prevalence of acute coronary syndrome among patients admitted for cardiovascular disease ranging from 0.21% to 22.3%. Patients were younger, with a minimum age of 52 years in South Africa and Djibouti. There was a significant male predominance. Hypertension was the main risk factor (50%-55% of cases). Time to admission tended to be long, with the longest times in Tanzania (6.6 days) and Burkina Faso (4.3 days). Very few patients were admitted by medicalized transport, particularly in Côte d'Ivoire (only 34% including 8% by emergency medical service). The clinical presentation is dominated by ST-elevation sudden cardiac arrest. Percutaneous coronary intervention is not widely available but was performed in South Africa, Kenya, Côte d'Ivoire, Sudan, and Mauritania. Fibrinolysis was the most accessible means of revascularization, with streptokinase as the molecule of choice. Hospital mortality was highly variable between 1.2% and 24.5% depending on the study populations and the revascularization procedures performed. Mortality at follow-up varied from 7.8% to 43.3%. Some studies identified factors predictive of mortality. Conclusions The significant disparities in our results underscore the need for a multicenter registry for acute coronary syndrome in sub-Saharan Africa in order to develop consensus-based strategies, propose and evaluate tailored interventions, and identify prognostic factors.

Prognostic value of admission hyperglycaemia in black Africans with acute coronary syndromes: a cross-sectional study.

AIM: The aim of the study was to determine the relationship between acute hyperglycaemia and in-hospital mortality in black Africans with acute coronary syndromes (ACS). METHODS: From January 2002 to December 2017, 1 168 patients aged ≥ 18 years old, including 332 patients with diabetes (28.4%), consecutively presented to the intensive care unit of the Abidjan Heart Institute for ACS. Baseline data and outcomes were compared in patients with and without hyperglycaemia at admission (> 140 mg/dl; 7.8 mmol/l). Predictors for death were determined by multivariate logistic regression. RESULTS: The prevalence of admission hyperglycaemia was 40.6%. It was higher in patients with diabetes (55.3%). In multivariate logistic regression, acute hyperglycaemia (hazard ratio = 2.33; 1.44-3.77; p < 0.001), heart failure (HR = 2.22; 1.38-3.56; p = 0.001), reduced left ventricular ejection fraction (HR = 6.41; 3.72-11.03; p < 0.001, sustained ventricular tachycardia or ventricular fibrillation (HR = 3.43; 1.37-8.62; p = 0.008) and cardiogenic shock (HR = 8.82; 4.38-17.76; p < 0.001) were predictive factors associated with in-hospital death. In sub-group analysis according to the history of diabetes, hyperglycaemia at admission was a predictor for death only in patients without diabetes (HR = 3.12; 1.72-5.68; p < 0.001). CONCLUSIONS: In ACS patients and particularly those without a history of diabetes, admission acute hyperglycaemia was a potentially threatening condition. Appropriate management, follow up and screening for glucose metabolism disorders should be implemented in these patients.

[Coronary lesions in black African patients with acute coronary syndromes]. / Lésions coronaires chez le noir africain dans les syndromes coronariens aigus.

INTRODUCTION: acute coronary syndromes (ACSs) have been increasing in sub-Saharan Africa. Coronary angiography data have been rarely reported. This study aims to investigate coronary lesions observed in patients with acute coronary syndromes (ACS) in Abidjan. METHODS: we conducted a cross-sectional study from 1st January 2010 to 31st December 2014. All patients with ACS admitted to the Abidjan Heart Institute and undergoing coronary angiography during the study period were included. Two hundred and fifty-six patients were selected. We investigated and compared coronary lesions in patients with ACS associated with persistent ST-segment elevation (ACS ST+) and in those with ACS without ST-segment elevation (ACS ST-). RESULTS: the average age of patients was 53.2 ± 10.8 years; there was a male predominance, with a sex ratio of 6.1. Abnormal coronary angiography rate was significantly higher in the STEMI group (95.4% and 64.2% respectively, p < 0.001). Three hundred and four coronary lesions were found in the STEMI group against 43 in the NSTE-ACS group. Stenotic lesions were predominantly one-vessel disease (45.3%) in the STEMI group and two or three-vessel disease in the NSTE-ACS group (68.0%). Type B1 lesions were more common in the NSTE-ACS group (62.8% versus 36.5%, p = 0.002). The most complex type C lesions were more commonly found in the STEMI group (17.8%), with no significant difference. The majority of patients had SYNTAX score less than 22, whatever the type of ACS (87.4% in the STEMI group and 90.1% in the NSTE-ACS group). CONCLUSION: coronary lesions in the patients group with STEMI were predominantly one-vessel disease and they were more diffuse in the NSTE-ACS group, but with a higher proportion of angiographically normal coronary arteries. The management of patients with these lesions is based in the majority of cases on coronary angioplasty.