CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 3, May/June 2022 AFRICA 141 Table 2 elaborates on the discharge treatment of all patients with ACS. Overall, 72% received a statin, 66.1% received aspirin, 59% a beta-blocker and 61% either an angiotensin converting enzyme inhibitor or angiotensin receptor blocker. As expected, clopidogrel was more frequently prescribed to patients with STEMI and NSTEMI than those with UAP (72.9 and 55.8%, respectively, vs 8.4%, p < 0.001). Similarly, those with STEMI and NSTEMI received beta-blockers more commonly than patients with UAP (79.2 and 60.5%, respectively, vs 47%, p = 0.001). Fifteen patients (8.6%) with ACS were referred for urgent PCI at a tertiary-level healthcare facility. These included 10 (23.26%) patients with NSTEMI (of whom seven were referred for post-infarct angina, one with ventricular tachycardia, one with pulmonary oedema and one for a NSTEMI after recent coronary artery bypass graft) and five (10.42%) with STEMI (of whom four patients had persistent ST-elevation and ongoing chest pain despite thrombolysis and one patient had pulmonary oedema). The in-hospital death rate at the secondary healthcare centre was 1.7%. Of those discharged, 47 patients (27.0%) re-presented to the emergency unit with a repeat episode of ACS within the first year after the index admission [9 (5.1%) with STEMI; 11 (6.32%) with NSTEMI; 27 (15.5%) with UAP]. Dyspnoea Syncope Palpitations Chest pain 4.6 20.7 66.6 1.7 2.3 1.2 0.6 0.6 Chest pain Palpitations Dyspnoea Syncope 75 2.1 2.1 14.6 2.1 2.1 Chest pain Syncope Palpitations Dyspnoea 60.5 20.9 9.3 2.3 2.3 2.3 Chest pain Dyspnoea Palpitations Syncope 65.1 24.1 1.2 1.2 3.6 1.2 0 0 Fig. 2. Clinical presentation of (A) all patients with ACS, (B) STEMI, (C) NSTEMI and (D) UAP patients. A C B D 100 90 80 70 60 50 40 30 20 10 0 Cumulative proportion (%) 3 6 9 12 > 12 Time (hours) STEMI NSTEMI UAP 98 98.9 100 56.3 51.9 52.1 44.7 41.7 31.4 16.7 13.3 11.6 25.6 41.9 51.2 100 90 80 70 60 50 40 30 20 10 0 Cumulative proportion (%) 3 6 9 12 > 12 Time (hours) Thrombolysis STEMI patients 16.7 10.4 41.7 25 31.3 52.1 56.3 33.4 37.6 98 Fig. 3. Time between symptom onset and FMC of (A) all patients with ACS, and (B) patients with STEMI and the proportion of patients receiving thrombolytic therapy over time. A B
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