Mohamed Hasham Varwani1, Mohamed Jeilan2, Mzee Ngunga2, Anders Barasa3. 1. Department of Medicine, the Aga Khan University Hospital, Nairobi, Kenya. Email: mhvarwani@gmail.com. 2. Department of Medicine, the Aga Khan University Hospital, Nairobi, Kenya. 3. Department of Medicine, the Aga Khan University Hospital, Nairobi, Kenya; Department of Clinical and Molecular Medicine, University of Gothenburg, Gothenburg, Sweden.
Abstract
BACKGROUND: Coronary artery disease and its acute presentation are being increasingly recognised and treated in sub-Saharan Africa. It is just over a decade since the introduction of interventional cardiology for coronary artery disease in Kenya. Local and regional data, and indeed data from sub-Saharan Africa on long-term outcomes of acute coronary syndromes (ACS) are lacking. METHODS: A retrospective review of all ACS admissions to the Aga Khan University Hospital, Nairobi (AKUHN) between January 2012 and December 2013 was carried out to obtain data on patient characteristics, treatment and in-patient outcomes. Patient interviews and a review of clinic records were conducted to determine long-term mortality rates and major adverse cardiovascular events. RESULTS: A total of 230 patients were included in the analysis; 101 had a diagnosis of ST-segment myocardial infarction (STEMI), 93 suffered a non-ST-segment myocardial infarction (NSTEMI), and 36 had unstable angina (UA). The mean age was 60.5 years with 81.7% being male. Delayed presentation (more than six hours after symptom onset) was common, accounting for 66.1% of patients. Coronary angiography was performed in 85.2% of the patients. In-hospital mortality rate was 7.8% [14.9% for STEMI and 2.3% for non-ST-segment ACS (NSTE-ACS, consisting of NSTEMI and UA)], and the mortality rates at 30 days and one year were 7.8 and 13.9%, respectively. Heart failure occurred in 40.4% of STEMI and 16.3% of NSTE-ACS patients. Re-admission rate due to recurrent myocardial infarction, stroke or bleeding at one year was 6.6%. CONCLUSIONS: In our series, the in-hospital, 30-day and one-year mortality rates following ACS remain high, particularly for STEMI patients. Delayed presentation to hospital following symptom onset is a major concern.
BACKGROUND:Coronary artery disease and its acute presentation are being increasingly recognised and treated in sub-Saharan Africa. It is just over a decade since the introduction of interventional cardiology for coronary artery disease in Kenya. Local and regional data, and indeed data from sub-Saharan Africa on long-term outcomes of acute coronary syndromes (ACS) are lacking. METHODS: A retrospective review of all ACS admissions to the Aga Khan University Hospital, Nairobi (AKUHN) between January 2012 and December 2013 was carried out to obtain data on patient characteristics, treatment and in-patient outcomes. Patient interviews and a review of clinic records were conducted to determine long-term mortality rates and major adverse cardiovascular events. RESULTS: A total of 230 patients were included in the analysis; 101 had a diagnosis of ST-segment myocardial infarction (STEMI), 93 suffered a non-ST-segment myocardial infarction (NSTEMI), and 36 had unstable angina (UA). The mean age was 60.5 years with 81.7% being male. Delayed presentation (more than six hours after symptom onset) was common, accounting for 66.1% of patients. Coronary angiography was performed in 85.2% of the patients. In-hospital mortality rate was 7.8% [14.9% for STEMI and 2.3% for non-ST-segment ACS (NSTE-ACS, consisting of NSTEMI and UA)], and the mortality rates at 30 days and one year were 7.8 and 13.9%, respectively. Heart failure occurred in 40.4% of STEMI and 16.3% of NSTE-ACS patients. Re-admission rate due to recurrent myocardial infarction, stroke or bleeding at one year was 6.6%. CONCLUSIONS: In our series, the in-hospital, 30-day and one-year mortality rates following ACS remain high, particularly for STEMI patients. Delayed presentation to hospital following symptom onset is a major concern.
Authors: Julian T Hertz; Francis M Sakita; Godfrey L Kweka; Alexander T Limkakeng; Sophie W Galson; Jinny J Ye; Tumsifu G Tarimo; Gloria Temu; Nathan M Thielman; Janet P Bettger; John A Bartlett; Blandina T Mmbaga; Gerald S Bloomfield Journal: Am Heart J Date: 2020-06-05 Impact factor: 4.749
Authors: Julian T Hertz; Francis M Sakita; Godfrey L Kweka; Tumsifu G Tarimo; Sumana Goli; Sainikitha Prattipati; Janet P Bettger; Nathan M Thielman; Gerald S Bloomfield Journal: Circ Cardiovasc Qual Outcomes Date: 2022-03-18
Authors: Simeon Isezuo; Mahmoud Umar Sani; Abdullahi Talle; Adeyemi Johnson; Abiodun-Moshood Adeoye; Mehmet S Ulgen; Amam Mbakwem; Okechukwu Ogah; Emmanuel Edafe; Philip Kolo; Murtala Nagabea; Rasaaq Adebayo; Eze Nwafor; Folasade Daniel; Muiyawa Zagga; Hayatu Umar; Isa Oboirien; Balarabe A Sulaiman; Umar Abdullahi; Muhammad Sani Mijinyawa; Farouk Buba; Akinyemi Aje; Henry Okolie; Muhammad Nazir Shehu; Umar Adamu; Akinsanya Olusegun-Joseph; Ranti Familoni; Nwuriku Chibuzor; Taiwo Olabisi Olunuga; Emmanuel Ejim; Awodu Rasheed Olaide; Dike Ojji; Bushra Sanni; Jane N Ajuluchukwu; Michael O Balogun; Ayodele B Omotoso; Mullasari Ajit; Ayodele O Falase Journal: J Am Heart Assoc Date: 2021-12-22 Impact factor: 6.106