Acute coronary syndromes: epidemiological, clinical, paraclinical and therapeutic characteristics at the Campus teaching hospital of Lome, Togo

Pessinaba, S.; Atti, Y.D.M.; Yayehd, Komlavi; Simwetare, MF; Kaziga, Wiyaou; Afassinou, Yaovi; Atta, Borgatia; Pio, Machihudé; Kpélafia, M.; Baragou, S; Damorou, F

doi:10.1684/mst.2018.0825

Cited by 4 publications

(13 citation statements)

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“…The clinical characteristics of our ACS population, including traditional risk factors of CAD, are similar to the findings among other African, 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 Asian, 26 and White 25 studies. However, our patients are about one and a half decades younger than the White patients, perhaps, because of shorter lifespan and probable earlier onset of risk factors and atherosclerosis among the Nigerian population.…”

Section: Discussionsupporting

confidence: 84%

“…This may potentially increase the tendency for delayed presentation and underrecognition of ACS in this subpopulation. STEMI was, like most other reports from Africa, 34 , 36 , 38 , 40 , 41 , 42 , 43 , 44 the most frequent type of ACS.…”

Section: Discussionsupporting

confidence: 71%

“…Given the low patients' eligibility and lack of health care infrastructural capacity for myocardial reperfusion, it is not surprising that our mortality profiles were higher than values from South Africa, 19 Asia, 26 , 47 and Europe. 48 , 49 However, they compare favorably with values ranging from 7.8% to 10.5% in some African countries 34 , 35 , 39 and lower than others ranging from 14% to 20%. 37 , 44 , 45 The determinants of ACS outcome are similar to other African, 37 , 39 , 45 Asian, 26 , 39 , 47 and White 48 , 49 study data.…”

Section: Discussionmentioning

confidence: 72%

“…These challenges are common in resource‐constrained nations and linked to ignorance, poverty, lack of a universal health insurance system, inadequate skilled manpower, and deficient health care infrastructure. 34 , 35 , 36 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 45 Consequently, we observed patient‐ and system‐related delays in presentation and low rates of reperfusion, especially thrombolysis and PCI. Sadly, cheap first‐generation nonspecific thrombolytic agents such as streptokinase, which is not a prioritized thrombolytic option in standard guidelines, is hardly affordable in Nigeria.…”

Section: Discussionmentioning

confidence: 91%

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Registry for Acute Coronary Events in Nigeria (RACE‐Nigeria): Clinical Characterization, Management, and Outcome

Isezuo

Sani

Talle

et al. 2022

JAHA

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Background Coronary artery disease was hitherto a rarity in Africa. Acute coronary syndrome (ACS) accounts for coronary artery disease–related morbidity and mortality. Reports on ACS in Africa are few. Methods and Results We enrolled 1072 indigenous Nigerian people 59.2±12.4 years old (men, 66.8%) with ACS in an observational multicentered national registry (2013–2018). Outcome measures included incidence, intervention times, reperfusion rates, and 1‐year mortality. The incidence of ACS was 59.1 people per 100 000 hospitalized adults per year, and comprised ST‐segment–elevation myocardial infarction (48.7%), non–ST‐segment–elevation myocardial infarction (24.5%), and unstable angina (26.8%). ACS frequency peaked 10 years earlier in men than women. Patients were predominantly from urban settings (87.3%). Median time from onset of symptoms to first medical contact (patients with ST‐segment–elevation myocardial infarction) was 6 hours (interquartile range, 20.1 hours), and only 11.9% presented within a 12‐hour time window. Traditional risk factors of coronary artery disease were observed. The coronary angiography rate was 42.4%. Reperfusion therapies included thrombolysis (17.1%), percutaneous coronary intervention (28.6%), and coronary artery bypass graft (11.2%). Guideline‐based pharmacotherapy was adequate. Major adverse cardiac events were 30.8%, and in‐hospital mortality was 8.1%. Mortality rates at 30 days, 3 months, 6 months, and 1 year were 8.7%, 9.9%, 10.9%, and 13.3%, respectively. Predictors of mortality included resuscitated cardiac arrest (odds ratio [OR], 50.0; 95% CI, 0.010–0.081), nonreperfusion (OR, 34.5; 95% CI, 0.004–0.221), pulmonary edema (OR, 11.1; 95% CI, 0.020–0.363), left ventricular diastolic dysfunction (OR, 4.1; 95% CI, 0.091–0.570), and left ventricular systolic dysfunction (OR, 2.1; 95% CI, 1.302–3.367). Conclusions ACS burden is rising in Nigeria, and patients are relatively young and from an urban setting. The system of care is evolving and is characterized by lack of capacity and low patient eligibility for reperfusion. We recommend preventive strategies and health care infrastructure‐appropriate management guidelines.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 91%

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Registry for Acute Coronary Events in Nigeria (RACE‐Nigeria): Clinical Characterization, Management, and Outcome

Isezuo

Sani

Talle

et al. 2022

JAHA

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“…Table 1 summarizes the characteristics of the 27 studies. 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 In 6 studies, the patients included were exclusively STEMI. 15 , 19 , 29 , 34 , 35 , 37 Table S3 show the 12 studies including patients hospitalized for MI.…”

Section: Resultsmentioning

confidence: 99%

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

Yao

Ekou

Niamkey

et al. 2022

JAHA

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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.

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Editorial: Global Excellence in Cardiovascular Medicine in Africa: challenges and opportunities

Garelnabi,

Ntsekhe,

Doubell

et al. 2024

Front. Cardiovasc. Med.

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Acute coronary syndromes: epidemiological, clinical, paraclinical and therapeutic characteristics at the Campus teaching hospital of Lome, Togo

Cited by 4 publications

References 0 publications

Registry for Acute Coronary Events in Nigeria (RACE‐Nigeria): Clinical Characterization, Management, and Outcome

Registry for Acute Coronary Events in Nigeria (RACE‐Nigeria): Clinical Characterization, Management, and Outcome

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

Editorial: Global Excellence in Cardiovascular Medicine in Africa: challenges and opportunities

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