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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 4, July/August 2020
AFRICA
201
Primary PCI in the management of STEMI in
sub-Saharan Africa: insights from Abidjan Heart Institute
catheterisation laboratory
Arnaud Ekou, Hermann Yao, Isabelle Kouamé, Rolande Yao Boni, Esther Ehouman, Roland N’Guetta
Abstract
Background:
Implementation of primary percutaneous coro-
nary intervention (PCI) in sub-Saharan Africa remains a
challenging issue. The aim of this study was to report the
results of primary PCI and outcomes in the catheterisation
laboratory of the Abidjan Heart Institute.
Methods:
Between April 2010 and March 2019, all patients
aged 18 years presenting to the Abidjan Heart Institute for
ST-segment elevation myocardial infarction (STEMI) over
the study period and who underwent primary PCI were
included. We considered primary PCI when it was performed
within 48 hours of the onset of symptoms. Baseline data, PCI
characteristics and outcomes were analysed.
Results:
Among a total of 780 patients hospitalised for
STEMI, 471 were admitted within 48 hours of the onset of
symptoms. One-hundred and sixty six patients underwent
primary PCI, with a ratio of primary PCI/STEMI of up to
21.3%. One hundred and six patients (63.9%) were admit-
ted within 12 hours of the onset of symptoms. The femoral
approach was the most commonly used (78.3%). Primary PCI
was performed with stent implantation in 84.3% of patients.
Drug-eluting stents (DES) were used in 42.1% of patients.
In most cases, angiographic success was observed (157/166,
94.6%). Non-fatal complications were mainly haematomas
(3.6%). Peri-procedural mortality rate was 1.2%.
Conclusion:
Primary PCI can be performed safely in some
small-volume centres in sub-Saharan Africa. Healthcare poli-
cies and regional networks must be encouraged in order to
improve management of STEMI patients.
Keywords:
percutaneous coronary intervention, STEMI, sub-
Saharan Africa
Submitted 4/2/20, accepted 26/5/20
Published online 12/6/20
Cardiovasc J Afr
2020;
31
: 201–204
www.cvja.co.zaDOI: 10.5830/CVJA-2020-012
Primary percutaneous coronary intervention (PCI) is now
the gold-standard reperfusion strategy in the management of
ST-segment elevation myocardial infarction (STEMI).
1,2
In the
West, shortening of admission delays and the implementation
of primary PCI have led to a sharp decline in morbidity and
mortality rates in STEMI patients,
3,4
In sub-Saharan Africa,
whereas acute coronary syndromes (ACS) have increased in
recent years,
5-7
only a few trained interventional cardiologists
and heart centres equipped with catheterisation laboratories
are available.
6-11
Yet coronary artery disease (CAD) is now the
leading cause of death in most of countries in sub-Saharan
Africa,
12
outweighing the burden of historic infectious
diseases.
Since April 2010, PCI has been performed safely at the
Abidjan Heart Institute (Côte d’Ivoire),
8
as in some other heart
centres in sub-Saharan Africa. The aim of this study was to
report the results of primary PCI and the challenges in our
catheterisation laboratory.
Methods
Our study was carried out at the Abidjan Heart Institute
(Côte d’Ivoire), a public heart centre capable of providing
cardiovascular care 24 hours a day and seven days a week.
We conducted a cross-sectional, observational study from 1
April 2010 to 31 March 2019 using data from the REPACI
(REgistre Prospectif des Actes de Cardiologie Interventionnelle
de l’institut de cardiologie d’Abidjan) study.
All patients aged 18 years presenting to Abidjan Heart
Institute for STEMI over the study period and who underwent
primary PCI were included. STEMI was defined by symptoms
of myocardial ischaemia, and ECG changes on two contiguous
leads with persisting ST-segment elevation ≥ 1 mm or
pathological Q-waves or new-onset of bundle-branch block, and
elevated serum markers of myocardial necrosis > 99th percentile
for troponin and creatine kinase-MB. We considered primary
PCI when it was performed within 12 hours of the onset of
symptoms, or between 12 and 48 hours in the presence of
ongoing pain, dynamic ECG changes, or threatening conditions
(heart failure, shock or malignant arrhythmias) and without
prior fibrinolysis.
1
Coronary angiography procedures and PCI were performed
using the Philips Integris V5000 cath lab. Since November
2016, our centre has been equipped with a new General Electric
Innova 530 S cath lab system.
Baseline data were entered into a standardised questionnaire
during hospitalisation. We collected for each patient:
cardiovascular risk factors and history, admission delay, Killip
class, location of STEMI, left ventricular ejection fraction
(LVEF), PCI characteristics, results and in-hospital outcomes.
Intensive Care Unit, Abidjan Heart Institute, Abidjan, Côte
d’Ivoire
Arnaud Ekou, MD
Hermann Yao, MD,
hermannyao@gmail.comIsabelle Kouamé, MD
Rolande Yao Boni, MD
Esther Ehouman, MD
Roland N’Guetta, MD