Medium and long-term follow-up after ST-segment elevation myocardial infarction in a sub-Saharan Africa population: a prospective cohort study

Abstract

BackgroundMajor in-hospital mortality rate in patients with ST-segment Elevation Myocardial Infarction (STEMI) in Sub-Saharan Africa has been reported. Data on follow-up in these patients with STEMI are scarce. We aimed to assess medium and long-term prognosis in patients with STEMI admitted to Abidjan Heart Institute.MethodsProspective cohort study including 260 patients admitted for STEMI to Abidjan Heart Institute, from January 1, 2012 to December 31, 2015. We compared mortality and nonfatal cardiovascular complications in revascularized and non-revascularized groups. Survival curve was generated with the Kaplan-Meier method. Predictors of mortality after STEMI were determined by multivariable Cox regression.ResultsOf the 260 patients followed up on a median period of 39 months [28–68 months], 94 patients (36.1%) were revascularized and 166 (63.8%) were non-revascularized. Crude all-cause mortality was 10.4%. It was significantly higher in non-revascularized patients (p = 0.04). There was no difference in the occurrence of nonfatal cardiovascular complications in the 2 groups. In multivariable Cox regression, age ≥ 70 years, female gender and heart failure were the predictive factors for death after adjustment.ConclusionsSTEMI remains an important cause of mortality in our practice. Healthcare policies should be developed to improve patient care and long-term outcomes.

Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

“…Most SSA countries have insufficient health care systems and infrastructure to manage CVDs with strong evidence of very limited number of hospitals equipped with the provision of specialist cardiac services in this region, including shortage of medications [18][19][20]. Tertiary centers for advanced cardiac imaging and invasive cardiac procedures including cardiac catherization, PCI, cardiothoracic and vascular surgical interventions are very sparsely available in most of SSA, apart from South Africa [18,61,123]. Electrophysiological study and catheter ablation centers are present only in very few countries in SSA and 26% of countries surveyed in this region do not have cardiac electronic implantable device implanting services [19].…”

ST Segment Yükselmeli Miyokard İnfarktüsü ile Başvuran Hastalarda Hastane İçi ve Uzun Dönem Mortalitenin Değerlendirilmesi: Üçüncü Basamak Kardiyoloji Merkezi Deneyimi

“…13 A median period of 39 months mortality among STEMI patients in a sub-Saharan Africa population is found to be 10.4%. 14 17 Moreover a rising gradient in mortality has been apparent aft er seventh decade, 18 II) the present study excluded the patients with heart failure and previous cardiac surgery that they would shorten the survival rate, III) it is proven that delay in door to-balloon time is a major contributor to mortality associated with STEMI. 19 In this context, the present study was carried out in a single tertiary cardiology center where unacceptable delays in door to-balloon time are not usual, and that might have a contribution to high survival rate.…”

Quality Evaluation in Delivering Care for Acute Myocardial Infarction in Sancti-Spirítus, Cuba

“…First, in northern African countries, attention seems to be dependent on patient's time for fi rst medical contact, as technologies and human resources appear to be available [21][22][23]. Second, in sub-Saharan countries attention looks to be really poor, based on absence of reperfusion treatment for most of patients, despite their delay time to seek for attention: few patients received thrombolytic, and a huge variation of system delay was observed, Betablockers and ACE-I administration didn't reach a quarter of available population [24][25][26]. And fi nally, in southern more-wealthy countries, attention seems to be as good as they can aff ord [27].…”