CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 4 AFRICA Cardiovascular Topics Percutaneous coronary intervention facilities in Nigeria Olufemi T Olorunda, Kelechukwu Okoro, Basil Okoh, Tosin Majekodunmi Abstract Background: In Nigeria, the incidence of coronary artery disease has doubled over the last three decades. However, there appears to be a lack of adequate heart catheterisation facilities. Methods: A list of percutaneous coronary intervention (PCI)- capable facilities was compiled for each state in Nigeria and the federal capital territory. Population estimates for 2019 were obtained from the National Bureau of Statistics and this was utilised to calculate the number of PCI facilities per person in each state and the country. Results: There are 12 operational PCI facilities in Nigeria, 11 of which are in the private health sector. Overall, there is one PCI facility per 16 761 272 people in Nigeria. Conclusions: There is a distinct lack of PCI-capable facilities in Nigeria. There needs to be an investment from the government and stakeholders in Nigeria to increase the access to PCI, given the paradigm shift from communicable to noncommunicable diseases. Keywords: percutaneous coronary intervention, acute coronary syndrome, Nigeria Submitted 20/3/22; accepted 27/7/22 Published online 9/2/24 Cardiovasc J Afr 2024; 35: 4–6 www.cvja.co.za DOI: 10.5830/CVJA-2022-041 Thereisaparadigmshiftfromcommunicabletonon-communicable diseases in sub-Saharan Africa.1-3 Cardiovascular disease is the second most common cause of death in Africa and is responsible for 10% of all deaths.4 The World Health Organisation estimated that 361 000 deaths were caused by ischaemic heart disease in Africa and projected that this number will double by 2030.1 In Nigeria, the incidence of coronary artery disease has doubled over the last three decades, and the incidence of acute coronary syndrome (ACS) was reported to be 45.98 per 100 000 hospitalised adults per year.3 The appropriate management of a ST-elevation myocardial infarction (STEMI) requires the prompt identification of the disease process, swift initiation of the pre-hospital system, transport to the appropriate hospital, medication administration, and rapid activation of the heart catheterisation laboratory.4-6 Management of ACS in Nigeria is limited by a non-existent prehospital emergency medical services system, delays in presentation and limited capabilities for reperfusion.3 This has led to a high rate of mortality and major adverse cardiac events.3 In Nigeria, there is a distinct lack of adequate heart catheterisation laboratory facilities.7 The coronary angiography rate for ACS in Nigeria was reported to be 42.4% and percutaneous coronary intervention (PCI) was performed on 28.6% of patients in a study by Isezuo et al.3 The goal of this article was to examine the availability of PCI-capable facilities in Nigeria. Methods A complete list of PCI-capable facilities in Nigeria was compiled by visiting some of the PCI facilities, performing multiple internet searches, and discussion with local physicians and cardiologists. The list of facilities was obtained for each state and the federal capital territory. Every PCI-capable facility was then contacted to verify whether their facility was operational. Facilities that were non-operational as of 28 January 2022 were excluded. The final list of PCI-capable facilities was verified by a local and interventional cardiologist in Nigeria. The population estimate for Nigeria for 2019 was obtained from the National Bureau of Statistics website.8 The number of PCI facilities per persons living in each state where the facility was available was calculated (Fig. 1). The number of PCI facilities per person for the country was also calculated. Results There was a total of 12 operational PCI-capable facilities identified in Nigeria (Table 1). Only six states had functional PCI facilities, with Lagos and Abuja having four each. The list of these PCI facilities is provided in (Table 2). The concentration of PCI facilities per state was the lowest in Rivers State (0.14/ 1 000 000 people) and the highest in Abuja (1.48/1 000 000 people) (Fig. 1). Division of Global Health, Department of Internal Medicine, Rush Medical College, Chicago, IL, USA Olufemi T Olorunda, MD, MPH, olorundaolufemi@gmail.com Department of Cardiology, Marshall University, Huntington, WV, USA Kelechukwu Okoro, MD Evercare Hospital, Lekki, Lagos, Nigeria Basil Okoh, MB BS Euracare Multi-Specialist Hospital, Victoria Island, Lagos, Nigeria Tosin Majekodunmi, MB BS, PhD
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