CARDIOVASCULAR JOURNAL OF AFRICA: AFRICA STEMI
ABSTRACTS, APR 2018
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- Title: Success Story of Stent Save a
Life Egypt in Past years
Authors: Sobhy Mohamed, Ragy Hany, Sadaka Mohamed, Okasha Nireen, Farag Sayed, Mehanna Radwa
From: Cardiovascular Journal of Africa, Africa STEMI Abstracts, April
Published: 2018
Pages: 1
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Following the success of the outstanding Stent For life program which was effective in Egypt from 2011, this initiative significantly improved the delivery of guidelines complying therapy and patient access to the lifesaving indication of primary percutaneous coronary intervention (p-PCI), thereby reducing mortality and morbidity in patients suffering from an acute myocardial infarction (AMI).
The unique platform for interventional cardiologists, government representatives, industry partners, advocacy groups and patients to work together and, by shaping the healthcare systems and medical practices, ensure that the majority of ST elevated myocardial infarction (STEMI) patients will have an equal access to the life-saving indication of primary percutaneous coronary intervention (p-PCI).
Despite the complex political situation in Egypt last years and several governmental changes, excellent engagement of MOH authorities was handled which made very good outcomes and achievements for acute interventional reperfusion strategy in STEMI in our country.
The objective was increasing the number of centers and hospitals involved in the project to include all Governmental hospitals and universities having cath-labs serving patients at the expense of the state, which pay the agreed reimbursement to centers for each patient treated, thus facilitate obtaining the right treatment for all patients and saving their lives without any delay related to financial procedures.
There is a potential need for spreading the practice of PCI in STEMI in developing countries and regions.
- Title: Preparedness towards acute coronary care in Kenya: A survey
of the county hospitals
Authors: Mohamed Hasham Varwani, Ahmed Hassan Dr., Mzee Ngunga, Anders Barasa Dr., Mohamed Jeilan
From: Cardiovascular Journal of Africa, Africa STEMI Abstracts, April
Published: 2018
Pages: 2-3
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Introduction: Coronary artery disease and acute coronary syndrome (ACS) in combination are already a major cause of death in subSaharan Africa with indication that they will become the leading cause of death by 2030. Successful management of ACS is dependent on the timeliness of presentation, recognition of the condition and prompt institution of successful therapy. The County Referral Hospital is the primary point of presentation for the vast majority of Kenyans with medical emergencies. We set out to determine the level of preparedness of County hospitals in the country, for the management of ACS and their potential complications.
Methods: We contacted frontline clinical staff at county hospitals distributed geographically across all Kenyan ‘provinces’ (outside the capital city, Nairobi) to determine access to expertise, to diagnostic and to therapeutic facilities at these centers. A structured questionnaire was administered to provide information for each facility. Staff were asked about access to ECG machines and cardiac enzyme testing, about their perceived expertise with regards resuscitation and ECG recognition, and about access to first line treatments including aspirin and thrombolysis, and about availability of critical care treatment within the county hospital.
Results: Data were collected in February 2018. Medical officers and/or internists from 25 county hospitals providing a broad geographical and administrative representation of Kenya were included in the survey. Two hospitals (8%) provide ECG within 30 minutes and none of the units currently has cardiac enzymes on site. 13 (52%) of the clinicans participating reported active ACLS certification/training and felt confident using a defibrillator independently. Aspirin was stocked for immediate use in 24 (96%) of the facilities and an alternative antiplatelet and heparin by 3 (12%) and 21(84%) of the hospitals, respectively. None of the respondents reported any access to thrombolysis within 60 minutes. Two (8%) of the surveyed county hospitals had a functioning defibrillator in the ER. A monitored unit was present in 4 of the 25 hospitals surveyed (16%).
Conclusions: Most facilities surveyed appear at the moment to be insufficiently equipped for management of ACS. This information indicates that healthcare providers and stakeholders must engage in ACS preparedness initiatives to meet the demands of a rising prevalence of coronary artery disease.
- Title: Determining the level of
agreement for atherosclerotic cardiovascular
disease risk stratification between coronary
artery calcium score and traditional
cardiovascular risk models
Authors: Menge Kuria, Sudhir Vinayak, Kevin Were, Harun Otieno
From: Cardiovascular Journal of Africa, Africa STEMI Abstracts, April
Published: 2018
Pages: 4
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Introduction: This study aimed to evaluate the value of transluminal attenuation gradient (TAG) of stress coronary computed tomography angiography (CCTA), using a widearea detector CT in patients with coronary artery disease, compared to stress perfusion cardiac magnetic resonance (CMR) imaging.
Methods: This prospective study from May 2012 to January 2015 included 21 patients with moderate coronary stenosis on invasive coronary angiography. All patients underwent adenosine stress single-shot CCTA with a rest CCTA scan using a wide-area detector CT. Coronary artery stenosis was evaluated on both stress and rest CCTA images, and TAG was manually obtained for all vessels. Stress perfusion CMR was used as a reference standard. A TAG cut-off value of –15.1 HU/10 mm was applied for diagnosing haemodynamically significant stenosis. The diagnostic accuracies of TAG and CMR were estimated and compared.
Results: TAG of stress CCTA in all coronary arteries had a sensitivity, specificity, and positive and negative predictive values of 90.5, 90.0, 86.4 and 93.1%, respectively. Corresponding values for TAG of rest CCTA in all coronary arteries were 42.9, 83.3, 64.3 and 67.6%, respectively, whereas those for TAG of coronary arteries with moderate stenosis on stress CCTA were 93.3, 100, 100 and 92.3%, respectively. Mean effective radiation doses for stress and rest CCTA were 10.6 ± 2.6 mSv and 2.3 ± 1.3 mSv, respectively.
Conclusions: TAG of CCTA provided high diagnostic accuracy for detecting haemodynamically significant coronary artery stenosis. TAG of stress CCTA was more diagnostically accurate, especially in coronary arteries with moderate stenosis.
- Title: Fibrinogen levels in Sudanese patients
with ST elevation myocardial infarction
Authors: Tadesse Teclebirhan, Ahmed Suliman
From: Cardiovascular Journal of Africa, Africa STEMI Abstracts, April
Published: 2018
Pages: 6
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Introduction: Elevated fibrinogen levels have been associated with higher risk for myocardial infarction (MI) and worse outcomes in patients who develop MI.
Aim: To study fibrinogen levels in Sudanese patients with acute ST-elevation MI
Methods: This is a prospective observational hospital based study conducted at Shab Teaching Hospital in Khartoum, Sudan. Eighty consecutive patients with acute myocardial infarction from June to Sep 2017 were enrolled. Fibrinogen levels were measured 72 hours after onset of MI.
Results: Mean age was 54.9±10.6 years and male to female ration was 3:1. Hypertension , diabetes mellitus and smoking were found in 35%, 44%, and 44% of patients respectively. Thrombolysis was administered in 79% of patients. The mean fibrinogen levels, were 393.8±100.1 mg/dl and the majority of the patients 62 (77.5%) had fibrinogen levels more than 346 mg/dl. Smoking, female gender and age between 40-60 years of age showed statistically significant levels with p values of 0.018, 0.002, 0.004 respectively. Hypertension, diabetes mellitus, thrombolysis and hemodynamic instability showed no significant relationship.
Conclusion: Sudanese patients with ST elevation MI have high incidence of elevated fibrinogen levels with significant relationship with female gender, age 40-60 years and smoking.
- Title: ECG changes in acutely ill
medical patients admitted to a resource poor
hospital in Uganda
Authors: Martin Opio, Teopista Namujwiga, Immaculate Nakitende, John Kellett
From: Cardiovascular Journal of Africa, Africa STEMI Abstracts, April
Published: 2018
Pages: 7
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Background: few studies report the prevalence of ECG changes in acutely ill medical patients in sub-Saharan Africa.
Methods: between August 10th 2016 and February 1st 2017 598 acutely ill medical patients were admitted and remained in the hospital for more than 24 hours: 430 (70%) of these patients (mean age 47.1 SD 22.4 years) had a 12 lead ECG performed within 24 hours of admission using a LevMed reusable ECG belt; 28 of them died in hospital (6.5%).
Results: 136 (31.6%) patients had one or more ECG abnormality: 13.3% had left ventricular hypertrophy (LVH), 10.5% ST depression, 4.0% left bundle branch block (LBBB), 3.3% Q waves, 1.2% right ventricular hypertrophy (RVH), 0.9% atrial fibrillation, and 0.7% right bundle branch block (RBBB). Patients with abnormal ECGs were older (51.1 SD 22.5 versus 45.2 SD 22.2 years, p 0.01) and sicker with a higher National Early Warning Score (4.4 SD 3.1 versus 3.8 SD 3.0, p 0.03). LVH was associated with higher systolic blood pressure; ST depression with lower oxygen saturations; LBBB with older age and higher systolic blood pressure; Q waves with lower oxygen saturation and increased respiratory rate, and atrial fibrillation with older age and a faster heart rate.
Conclusion: nearly a third of acutely ill patients had an abnormal ECG, suggesting they had cardiac disease prior to their acute illness. These patients were older and more severely ill. LVH and ST depression were the commonest abnormalities. These initial findings suggest that there may be higher burden of cardiovascular disease than what has been previously thought in rural areas of Uganda and possibly other countries in the Sub Saharan region. Further studies are needed to confirm these findings in the general population
- Title: An online survey on the clinical use of the 12-lead
electrocardiograph amongst East African health care professionals.
Authors: Harun A. Otieno
From: Cardiovascular Journal of Africa, Africa STEMI Abstracts, April
Published: 2017
Pages: 8
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Background: The burden of heart disease is growing worldwide, and the majority of those affected are in low & middle income countries.(1) In Africa cardiovascular disease account for 11% of total deaths(2) and is now the second most common cause of death after infectious disease. The 12-lead electrocardiograph plays an important diagnostic tool for detecting and managing cardiovascular disease. It is estimated that less than half of hospitals in Kenya and Uganda have functional ECG machines available limiting the capacity to diagnose CVD.(3)
Aim: To evaluate the clinical use of 12-lead electrocardiograph amongst health care workers in East Africa in public and private health facilities.
Methods & Materials: Using an online survey sent to the national cardiac society members of each country, we obtained information on the clinical use and characteristics of the ECG in hospital and clinic settings.
Results: There were 199 respondents representing 120 healthcare facilities from 5 countries. Kenya had 59 and Burundi 33, represented. In Kenya, only 21% of lower level public health facilities had an ECG machine. In Kenya, in 59% of facilities ECGs were interpreted by a doctor, physician or cardiologist. In Burundi 72% of public facilities had an ECG.
Conclusions & Recommendations: There is a need to improve CVD diagnosis by equipping and training more public facilities in East Africa with ECG machines and training healthcare workers with ECG application and interpretation.
- Title: Investigation of atrial conduction time on effect of
pulmonary vein isolation applied with left atrial catheter ablation in patients
have paroxysmal atrial fibrillation
Authors: İbrahim Dönmez
From: Cardiovascular Journal of Africa, Africa STEMI Abstracts, April
Published: 2018
Pages: 9
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Background and aim: Atrial fibrillation(AF) causes structural, electrical and cellular remodeling in the atrium. Intra-and interatrial conduction time evaluation which is measured by tissue doppler echocardiography indicates structural and electrical remodeling. Paroxysmal atrial fibrillation (PAF) treated with rhythm control strategy in the meta-analysis has been demonstrated that in ensuring and protection to sinus rhythm radiofrequency (RF) ablation superior to anti-arrhythmic. The aim of this study was the evaluate the effect of pulmonary vein isolation applied with RF ablation therapy on atrial conduction time and to investigate effect of structural and electrically remodeling after treatment.
Methods: Fifty-two patients with symptomatic PAF despite at least one antiarrhythmic drug and without structural heart disease were included the study. Two patients were excluded because of complications during and after the operation. CARTO 3D pulmonary vein isolation applied with RF ablation system performed 50 patients (28 women; mean age: 51.68 ± 11.731; mean left atrial diameter: 36.79 ± 4.318) were followed. In all patients measured intra-and interatrial conduction time by tissue doppler echocardiography before and three months after the operation.
Results: Patients who had RF ablation after three months measured all intra and interatrial conduction was a significant reduction in the duration. (PA lateral p = 0.022; PA septum p = 0.002; PA tricuspid p = 0.019; interatrial conduction delay p = 0,012; intra-atrial conduction delay p = 0.029).
Conclusions: The result of our study; the elimination of the AF starting mechanism by RF ablation of pulmonary vein isolation in patients who not yet formed atrial fibrosis and permanent structural changes can be to slow, stop and eve brings to mind the possibility of recovery from AF-induced structural remodeling by providing stable sinus rhythm.
- Title: Outcome of pulmonary
hypertension in pregnancy: Experience from
resource limited setting in a university
hospital in northern Ethiopia
Authors: Abraha Hailu, Awol Yeman, Ermias Abate, Haftom Berhe, Anna Whelan, Joan Briller, Heather Nixon, Gelila Goba
From: Cardiovascular Journal of Africa, Africa STEMI Abstracts, April
Published: 2018
Pages: 10-11
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Introduction: Pulmonary hypertension (PH) is a rare disease and when associated with pregnancy can be devastating. In the developed world, maternal mortality from PH has decreased from 56% in the 1970s to 16% as of 2014. In the developing world, there are still many challenges in the management of these cases.
Objective: to review the management of such patients in a resource limited setting from September 2016 to September 2017.
Methods: Cases with severe PH were identified from high risk antenatal care follow up, cardiology clinic and wards. Severity and type of pulmonary hypertension, NYHA functional status, mode of delivery and anesthesia as well as neonatal and maternal outcomes were noted.
Results: 20 cases of severe PH were reviewed. Seventeen of the patients had chronic rheumatic valvular heart disease (RHD) as the cause of PH (81% Group 2 PH, with average mitral valve area was 0.9sqcm) and 3 had combined RHD and Congenital Heart Defects (CHD) and one isolated CHD. The average pulmonary arterial pressure as measured on Echocardiography was 102.9 mmHg (SD 16.9). Fourteen of the patients had NYHA functional class III or more (66.7%), 10 patients underwent cesarean deliveries, 5 underwent vaginal deliveries with assisted second stage Two patients underwent termination of pregnancy at 16 & 19 weeks and are alive. There were 4 maternal deaths (19.1%) with a mean age at death of 28 years (SD 5.3). Death was caused by pulmonary edema in 2 cases and pulmonary venous thromboembolism in 2 cases. 76.2% of pregnancies resulted in live birth.
Conclusion: Group 2 PH caused by mitral stenosis complicating pregnancy continues to be a significant contributor in our set up. Although these cases were managed in a low resource setting, the outcomes are comparable to studies from the developed world. Multidisciplinary team treatment including cardiology, anesthesia, and obstetrics is important to improve maternal and fetal outcomes.
- Title: ICD implantation in post MI LV dysfunction: A sub Saharan
Centre experience
Authors: Mohamed Hasham Varwani, Mohamed Jeilan
From: Cardiovascular Journal of Africa, Africa STEMI Abstracts, April
Published: 2018
Pages: 12
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Introduction: Reduced LV systolic function after myocardial infarction increases the risk of sudden cardiac death from malignant arrhythmias. Several studies have demonstrated that prophylactic ICD implantation in this group of patients reduces all-cause mortality. Current guidelines recommend ICD therapy for patients who are at least 40 days post MI and have an LVEF of less than or equal to 35% and are in NYHA class II-III. Worldwide use of ICDs in this population remains low. ICD therapy in the region is relatively new and data regarding use of ICD therapy in sub Saharan Africa are scarce. We audited our referral and recommendation patterns to study the utilization and practice of this treatment among cardiologists at a tertiary level referral facility in Kenya.
Methods: All patients admitted with a myocardial infarction during the first half of 2017 were included. The echocardiograms performed during the admission were reviewed and patients with an LVEF of less than or equal to 35% selected for chart review. We specifically determined whether patients fulfilling ACC guidelines were offered ICD therapy. Contraindications to ICD therapy were also noted.
Results: A total of 92 patients were admitted with a myocardial infarction between January and June 2017. Of these, 14 patients (15.2%) had an LVEF of less than or equal to 35% documented by echocardiogram. None of these patients had a contraindication to ICD therapy. ICD therapy was offered to 5 patients (35.7%) with a high uptake in the group offered. The median duration of MI to ICD implantation was 36 days.
Conclusions: This analysis of the practice among cardiologists at a referral facility in sub Saharan Africa suggests underutilization of ICD therapy in this setting although the uptake of ICD is relatively in line with current European trends. The reasons behind underutilization are likely multifactorial and need to be further elucidated.
- Title: Clinical Profile and risk factors of Acute Coronary Syndrome
in Cardiac Care Unit patients at Elobied Hospital
Authors: Khalid Mohamed Eisa Eltalib, Abdelsalam Mohamed Hamad Elfaki, Ahmed Suliman
From: Cardiovascular Journal of Africa, Africa STEMI Abstracts, April
Published: 2018
Pages:13
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Introduction: Acute coronary syndrome ( ACS) is a major cause of mortality worldwide and its incidence is rising in Sub- Saharan Africa. Limited data on ACS are available from the African continent especially from areas away from capital cities.
Objective: To study clinical profile, risk factors and hospital outcomes in patients admitted to Elobied hospital in Northern Kordofan state in the western region of Sudan.
Methods: This is a retrospective study of all patients admitted to the coronary care unit ( CCU) in Elobied hospital from July 2014 to November 2015. Data was collected from patients charts regarding demographic data, risk factors, electrocardiographic patterns and hospital outcomes.
Results: Total number of patients was 84 with mean age of 58 years. Males were 56% and females 44%. Diabetes mellitus, hypertension and smoking was present in 57%, 33%, and 27% respectively. ST elevation myocardial infarction constituted 44 % of all ACS. Those referred for coronary angiography were 61%. Total mortality was 2% .
Conclusion: ACS occur at relatively young age in our population with high prevalence of diabetes mellitus, hypertension and smoking. Despite lack of invasive angiography overall hospital mortality was low.
