Diagnostic and Therapeutic Challenges of NON-ST-Elevation Myocardial Infarction in Sub-Saharian Africa

Abstract

Introduction: Non-ST-elevation myocardial infarction (NonSTEMI) is most often associated with a non-occlusive coronary lesion. However, mortality remains high. The aim of this study was to evaluate the diagnostic and evolutionary aspects of patients presenting with NonSTEMI. Patients and methods: This was a descriptive cross-sectional study conducted from January 01, 2021 to June 31, 2021 in the cardiology department of Aristide Le Dantec Hospital It included all patients hospitalized for NonSTEMI in the study period. The data studied were clinical, paraclinical, therapeutic and evolutionary. Results: A total of 52 patients were included. Mean age was 60.69 years, with extremes of 32 and 86 years. The most common risk factors were hypertension (58.85%), diabetes (34.62%) and smoking (30.7%). Chest pain was the main symptom (73.1%). On physical examination, signs of heart failure were noted in 19.2% of cases. Troponinemia was positive in 94.2% of patients. Repolarization disorders occurred most frequently in the lateral territory (55.4%). ST-segment depression was most common (75%). Doppler echocardiography revealed segmental kinetic disorders in 22 patients (42.3%). Coronary angiography was performed in 36 patients. Significant lesions were found in 63.8% of cases, most often tri-truncular (56.5%). Fourteen patients underwent angioplasty. In-hospital mortality was 3.8%. Conclusion: NonSTEMI is a frequent clinical form of acute coronary syndrome, occurring most often in high-risk patients. It is the expression of coronary lesions that are often severe.