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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 1, January/February 2018
6
AFRICA
Cardiovascular Topics
The proportion of South Africans living within 60 and
120 minutes of a percutaneous coronary intervention
facility
Willem Stassen, Lee Wallis, Craig Vincent-Lambert, Maaret Castren, Lisa Kurland
Abstract
Introduction:
Timely reperfusion, preferably via percutaneous
coronary intervention (PCI) following myocardial infarction,
improves mortality rates. Emergency medical services play
a pivotal role in recognising and transporting patients with
ST-elevation myocardial infarction directly to a PCI facility to
avoid delays to reperfusion. Access to PCI is, in part, depend-
ant on the geographic distribution of patients around PCI
facilities. The aim of this study was to determine the propor-
tion of South Africans living within 60 and 120 minutes of a
PCI facility.
Methods:
PCI facility and population data were subjected to
proximity analysis to determine the average drive times from
municipal ward centroids to PCI facilities for each province in
South Africa. Thereafter, the population of each ward living
within 60 and 120 minutes of a PCI facility was extrapolated.
Results:
Approximately 53.8 and 71.53% of the South African
population live within 60 and 120 minutes of a PCI facility.
The median (IQR, range) drive times and distances to a PCI
facility are 100 minutes (120.4 min, 0.7–751.8) across 123.6
km (157.6 km, 0.3–940.8).
Conclusion:
Based on the proximity of South Africans to PCI
facilities, it seems possible that most patients could receive
timely PCI within 120 minutes of first medical contact.
However, this may be unlikely for some due to a lack of medi-
cal insurance, under-developed referral networks or other
system delays. Coronary care networks should be developed
based on the proximity of communities to 12-lead ECG and
reperfusion therapies (such as PCI facilities). Public and
private healthcare partnerships should be fortified to allow
for patients without medical insurance to have equal accesses
to PCI facilities.
Keywords:
myocardial infarction, healthcare disparities, percuta-
neous coronary intervention, South Africa
Submitted 18/5/17, accepted 14/1/18
Cardiovasc J Afr
2018;
29
: 6–11
www.cvja.co.zaDOI: 10.5830/CVJA-2018-004
Ischaemic heart disease (IHD) is projected to double in incidence
within sub-Saharan Africa within the next few years.
1,2
For
a variety of reasons, African healthcare services may not
be prepared to manage these lifestyle diseases.
3
ST-elevation
myocardial infarction (STEMI), a time-sensitive consequence
of cardiovascular disease progression, should be managed
emergently in order to decrease morbidity and mortality rates.
4-8
According to the American and South African Heart
Associations, percutaneous coronary intervention (PCI) is the
preferred method of reperfusion for STEMI, and should be
performed within 120 minutes of first medical contact.
4,9,10
Despite this recommendation, only 61.3% of patients who
present with STEMI in South Africa receive reperfusion via PCI
within 24 hours. In 34.8% of patients, the indication for PCI was
failed thrombolysis.
11
For patients who cannot reach a PCI facility within 120
minutes, it is recommended that reperfusion be obtained by
means of thrombolytic therapy within 30 minutes of first medical
contact. This could be initiated by pre-hospital emergency care
providers.
4
Delayed reperfusion can be attributed to: late patient
presentation, protracted pre-hospital response and scene times,
delays in 12-lead ECG acquisition and STEMI diagnosis,
transport to non-PCI facilities requiring secondary interfacility
transfer, and PCI preparation time.
12-14
Department of Clinical Research and Education,
Karolinska Institute, Stockholm, Sweden; and Division
of Emergency Medicine, Stellenbosch University,
Stellenbosch, South Africa
Willem Stassen, BTEMC, MPhil,
stassen88@gmail.comDivision of Emergency Medicine, Stellenbosch University,
Stellenbosch, South Africa
Lee Wallis, MB ChB, FRCEM, MD
Department of Emergency Medical Care, University of
Johannesburg, Johannesburg, South Africa
Craig Vincent-Lambert, BTEMC, MEd, PhD
Department of Clinical Research and Education,
Karolinska Institute, Stockholm, Sweden; and Department
of Emergency Medicine and Services, Helsinki University,
Helsinki, Finland
Maaret Castren, MD, PhD,
Department of Clinical Research and Education,
Karolinska Institute, Sweden; and Department of Medical
Sciences, Örebro University, Örebro, Sweden
Lisa Kurland, MD, PhD