Background: Data in the literature on acute coronary syndrome in sub‐Saharan Africa are scarce. Methods and Results: We conducted a systematic review of the MEDLINE (PubMed) database of observational studies of acute coronary syndrome in sub‐Saharan Africa from January 1, 2010 to June 30, 2020. Acute coronary syndrome was defined according to current definitions. Abstracts and then the full texts of the selected articles were independently screened by 2 blinded investigators. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses standards. We identified 784 articles with our research strategy, and 27 were taken into account for the final analysis. Ten studies report a prevalence of acute coronary syndrome among patients admitted for cardiovascular disease ranging from 0.21% to 22.3%. Patients were younger, with a minimum age of 52 years in South Africa and Djibouti. There was a significant male predominance. Hypertension was the main risk factor (50%–55% of cases). Time to admission tended to be long, with the longest times in Tanzania (6.6 days) and Burkina Faso (4.3 days). Very few patients were admitted by medicalized transport, particularly in Côte d'Ivoire (only 34% including 8% by emergency medical service). The clinical presentation is dominated by ST–elevation sudden cardiac arrest. Percutaneous coronary intervention is not widely available but was performed in South Africa, Kenya, Côte d'Ivoire, Sudan, and Mauritania. Fibrinolysis was the most accessible means of revascularization, with streptokinase as the molecule of choice. Hospital mortality was highly variable between 1.2% and 24.5% depending on the study populations and the revascularization procedures performed. Mortality at follow‐up varied from 7.8% to 43.3%. Some studies identified factors predictive of mortality. Conclusions: The significant disparities in our results underscore the need for a multicenter registry for acute coronary syndrome in sub‐Saharan Africa in order to develop consensus‐based strategies, propose and evaluate tailored interventions, and identify prognostic factors.

Major in-hospital mortality rate in patients with ST-segment Elevation Myocardial Infarction (STEMI) in Sub-Saharan Africa has been reported. Data on follow-up in these patients with STEMI are scarce. We aimed to assess medium and long-term prognosis in patients with STEMI admitted to Abidjan Heart Institute. Prospective cohort study including 260 patients admitted for STEMI to Abidjan Heart Institute, from January 1, 2012 to December 31, 2015. We compared mortality and nonfatal cardiovascular complications in revascularized and non-revascularized groups. Survival curve was generated with the Kaplan-Meier method. Predictors of mortality after STEMI were determined by multivariable Cox regression. Of the 260 patients followed up on a median period of 39 months [28–68 months], 94 patients (36.1%) were revascularized and 166 (63.8%) were non-revascularized. Crude all-cause mortality was 10.4%. It was significantly higher in non-revascularized patients (p = 0.04). There was no difference in the occurrence of nonfatal cardiovascular complications in the 2 groups. In multivariable Cox regression, age ≥ 70 years, female gender and heart failure were the predictive factors for death after adjustment. STEMI remains an important cause of mortality in our practice. Healthcare policies should be developed to improve patient care and long-term outcomes.

High blood pressure (BP) is the main contributor to the global burden of chronic disease, reaching 10 million deaths each year.1 In Africa, 130.2 million people

Introduction: acute coronary syndromes (ACSs) have been increasing in sub-Saharan Africa. Coronary angiography data have been rarely reported. This study aims to investigate coronary lesions observed in patients with acute coronary syndromes (ACS) in Abidjan. Methods: we conducted a cross-sectional study from 1st January 2010 to 31st December 2014. All patients with ACS admitted to the Abidjan Heart Institute and undergoing coronary angiography during the study period were included. Two hundred and fifty-six patients were selected, We investigated and compared coronary lesions in patients with ACS associated with persistent ST-segment elevation (ACS ST+) and in those with ACS without ST-segment elevation (ACS ST-). Results: the average age of patients was 53.2 +/- 10.8 years; there was a male predominance, with a sex ratio of 6.1. Abnormal coronary angiography rate was significantly higher in the STEMI group (95.4% and 64.2% respectively, p < 0.001). Three hundred and four coronary lesions were found in the STEMI group against 43 in the NSTE-ACS group, Stenotic lesions were predominantly one-vessel disease (45.3%) in the STEMI group and two or three-vessel disease in the NSTE-ACS group (68.0%), Type B1 lesions were more common in the NSTE-ACS group (62.8% versus 36.5%, p = 0.002), The most complex type C lesions were more commonly found in the STEMI group (17.8%), with no significant difference, The majority of patients had SYNTAX score less than 22, whatever the type of ACS (87.4% in the STEMI group and 90.1% in the NSTE-ACS group). Conclusion: coronary lesions in the patients group with STEMI were predominantly one-vessel disease and they were more diffuse in the NSTE-ACS group, but with a higher proportion of angiographically normal coronary arteries. The management of patients with these lesions is based in the majority of cases on coronary angioplasty.

Background: From a large observational acute coronary syndrome registry in Côte d'Ivoire, we aimed to assess incidence, clinical presentation, management, and in‐hospital outcomes for type 2 myocardial infarction (T2MI) compared with type 1 MI. Methods and Results: We conducted a cross‐sectional monocentric study using data from REACTIV (Registre des Infarctus de Côte d'Ivoire) at the Abidjan Heart Institute. All patients hospitalized with MI between 2018 and 2022 who underwent coronary angiography were included. For each patient, sociodemographic data, cardiovascular risk factors and history, and clinical and paraclinical presentation were collected at admission. In‐hospital outcomes, including major adverse cardiovascular events and mortality, were reported. Among 541 consecutive patients hospitalized with MI, 441 met the definition of type 1 MI or T2MI. T2MI accounted for 14.1% of cases. Patients with T2MI showed a trend toward slightly younger age (54 versus 58 years, P =0.09). Patients with T2MI seemed to have less severe coronary artery disease, with less frequent multivessel disease ( P <0.001). Main triggering factors for T2MI were coronary embolism (24.2%), severe hypertension with or without left ventricular hypertrophy (22.6%), and tachyarrhythmia (16.1%). In‐hospital event rates were low in both MI types. Although the difference was nonsignificant, death rates for patients with type 1 MI tended to be higher than for patients with T2MI, as well as occurrence of major adverse cardiovascular events. Conclusions: Our study revealed disparities in clinical characteristics, angiographic features, cause, and in‐hospital outcomes in T2MI in our population compared with Western populations. These results suggest the heterogeneity of T2MI and the potential causative and demographic variability depending on geographical area.