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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 4, July/August 2020
168
AFRICA
The European Association of Percutaneous Intervention
(EAPCI) has recently published an atlas of PCI activities within
15 countries who are members of the ESC. Egypt is the sole
African representative. Per million population in high-income
countries, the number of cath labs, interventional cardiologists
and PPCI cases are far higher than in middle- and low-income
countries (LMIC). The disparity between countries is shown to
have a direct relationship with each country’s GDP. For example,
the average number of PPCI in high-income states is about 500
per million per annum compared to Egypt of 37 per million per
annum.
PPCI is, and should remain, the treatment of choice for
STEMI management. In most IMC countries it is likely to be
available as first-line treatment in a small number of patients
only.
At least for the foreseeable future in sub-Saharan Africa,
money may be better spent on community efforts to adopt
and prioritise a facilitated PCI strategy, which will mandate
educating communities, training staff, developing networks
for peripheral thrombolysis and developing transport systems
to increase the number of patients with STEMI that receive
appropriate treatment promptly. ‘Time is muscle’.
A recent geospacial analysis for a proposed coronary
care network model suggests that, at least in South Africa,
consolidating existing PCI facilities in certain regions would
make PPCI a realistic target.
5
Under the auspices of a number of national societies from
LMIC, an extensive document has been recently published
detailing the way forward in tackling the problems.
The advent of COVID-19 has required a reassessment
of STEMI programmes worldwide, with thrombolysis being
frequently preferred to obviate the risk of viral infections in
the cath labs. Also the underlying pathophysiology seems to be
largely thrombotic coronary occlusions rather than significant
coronary disease. COVD-19 will be making a significant impact
on health services in Africa for the foreseeable future and
budgets may be constrained for the development of more PPCI
facilities, making fibrinolysis an even more practical target for
peripheral centres.
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