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.

Acute coronary syndromes (ACS) are the leading cause of death among the elderly in sub-Saharan Africa. The aim of this study was to analyze the characteristics of ACS among the elderly at the Abidjan Heart Institute. Cross-sectional study from January 1, 2015, to December 31, 2019. All patients aged 18 or more admitted to the Abidjan Heart Institute for ACS were included. These patients were divided into two groups: elderly (≥ 65 years old) and non-elderly (< 65 years old). Clinical data, management and outcomes were compared and analyzed in both groups. A total of 570 patients were included, of which 137 (24%) were elderly. Sixty percent (60%) of elderly patients presented with ST Segment Elevation Myocardial Infarction (STEMI). Percutaneous coronary intervention (PCI) was less performed among elderly patients (21.1% vs 30.2%, p = 0.039). Heart failure was the most important complication among the elderly group (56.9% vs 44.6%, p = 0.012). In-hospital mortality was 8% among the elderly. Predictive factors for in-hospital mortality were history of hypertension (HR 2.58; CI95% 1.10-6.08) and STEMI presentation (OR 11.60; CI95% 2.70-49.76). PCI was a protective factor for in-hospital mortality (OR 0.14; IC95% 0.03-0.62). ACS occur with increasing frequency with age. Poor outcomes among the elderly are determined by the clinical presentation and comorbidities. PCI appears to significantly reduce in-hospital mortality.

Heart rate recovery (HRR) measured during stress tests, assesses the vago-sympathetic balance. It is a known prognostic and predictive parameter of cardiovascular mortality that is believed to be correlated with the presence and severity of coronary artery disease. The aim of this work was to assess the predictive value of heart rate recovery in the diagnostic and severity of coronary lesions in a major metropolis of sub-Saharan Africa where access to specialist care is unevenly distributed. We conducted a retrospective observational study from January 2010 to February 2020 at the Abidjan Cardiology Institute, including patients who performed a diagnostic coronary angiography after a positive exercise test. Clinical, angiographic and exercise parameters were analyzed and compared in patients with abnormal heart rate recovery (HRR) and those with normal one. The main study limitation is small sampling due to the cost of the angiographic procedure which limits its realization. We recorded 41 subjects whose mean age was 53.4 ± 9.6 years with a male predominance (sex ratio of 3.6). The predominant age group was between 50 and 60 years. Males were older than females with no significant difference. The predominant cardiovascular risk factors were overweight/obesity (68.29%) and hypertension (61%). Eight patients (19.5%) presenting an abnormal HRR (≤12 bpm) had more significant coronary disease (p=0.02) and more severe ones (p=0.003). Patients with abnormal HRR tended to be older without statistical significance (p=0.081), and had lower chronotropic reserve and maximum heart rate (p=0.008 and p=0.042, respectively). The positive predictive value of HHR was 87.5% and its negative predictive value was 60.6%. Abnormal HRR can predict the presence of coronary artery disease and its severity. Evaluating HRR during stress tests could help in the detection, evaluation, and monitoring of ischemic heart disease in our resource-limited countries.

The implantation of health structures in Côte d'Ivoire to improve geographical accessibility to care remains unequal between rural and urban areas. The medical student has to decide on his or her career choice in this context, while also taking into account personal preferences. The aim of our study was to evaluate the factors influencing the speciality choice of medical students at the faculty of medicine of Félix Houphouët-Boigny University in Abidjan. Medical students enrolled in the 6th year completed an anonymous self-administered questionnaire. The questionnaire was in paper format and was divided into three parts: socio-demographic criteria; speciality choice; and factors influencing career choice. Students were asked to rate the extent to which they perceived each of the 24 items as influencing their career choice using a Likert scale ranging from 1 (no influence) to 5 (strong influence). The factors were compared according to the speciality choice (medical or surgical). The 3 most chosen specialties were: cardiology (17.9%), gynaecology-obstetrics (15.7%) and paediatrics (9.6%). The desire to take the internship competition was more frequent among students who chose a surgical speciality (p = 0.02). The choice of a medical speciality was more influenced by the willingness to work part-time (p = 0.04). Students who choose a medical speciality were more guided by social commitment than those who chose a surgical speciality (p = 0.04). In contrast, the latter were more influenced by prestige among colleagues (p = 0.04) and immediate postoperative outcomes (p = 0.01). The efficient equipment of health structures could contribute to the development of other less chosen specialities by making them more attractive. A reorganisation of the system with the deployment of teachers in regional hospitals with a minimum of equipment is indispensable in order to allow a "decentralization" of the specialization curriculum, especially for the surgical specialties.As for the aspiration to part-time work, it can be explained by the need to reconcile family and professional life, but also by a sometimes unspoken project to develop a lucrative extra-medical activity in order to make up insufficient wages.