Abstract 15431: Barriers to Percutaneous Coronary Intervention in Sub Saharan Africa: A Call to Action

Abstract

Introduction: Myocardial infarction incidence is rising in Sub-Saharan Africa (SSA). Currently, 80% of the world cardiovascular disease mortality burden is by low- and middle-income countries. SSA countries have limited access to trained interventional cardiologists and medical centers where Percutaneous Coronary Intervention (PCI) is performed. Methods: In this review, Google Scholar and PubMed were used to search literature on PCI in SSA. Selection criteria were manuscripts published between 2013-2023, written in English language, and addressed the hurdles with PCI. Results: Between April 2010 and March 2019, patients presenting to a PCI-capable center in Abidjan, Côte d’Ivoire had a median delay of 20 hours from onset of symptoms to admission. This was 53.2 hours in Senegal, 4.35 days in Burkina-Faso, and 6.6 days in Tanzania, while it was between 2.3 to 3.6 hours in South Africa. In terms of availability of PCI-capable centers in East and Central Africa; Kenya, Ethiopia Tanzania, and Uganda 5, 3, 2, and 1 center (s) respectively. In West Africa; Nigeria, Senegal, Ghana, Côte d’Ivoire and Cameroon had 6, 4, 2, 1, and 1 center(s), respectively. The average cost of an uncomplicated PCI of a single vessel occlusion costs up to $3500 (R65,000/1,612,000). In SSA, due to limited access to medical insurance, the proportion of direct out-of-pocket payments in total health expenditure remains above 40%. Conclusions: Minimizing ST-elevation Myocardial Infarction care and PCI delay should be a public health priority, as it a matter of public health interest and global health equity. There is a need for research into understanding better ways to improve access to STEMI care in Africa.