Abidjan Heart Institute Research Articles

OPTIMISATION DU TRAITEMENT DE L'INSUFFISANCE CARDIAQUE A L'INSTITUT DE CARDIOLOGIE D'ABIDJAN

The aim of the study was to assess the level of treatment optimization after follow-up at discharge. We conducted a retrospective study carried out from January 1st, 2016 to December 31st, 2018 in Abidjan Heart Institute with patients hospitalized for heart failure and reviewed in consultation. The study involved 350 patients with an average age of 53.53 ± 16.38 years (54% were males). The prescription of diuretics (92%) after optimization was at the mean and with maximum doses of 29.1% and 7.7%. ACEIs/ARBs (77.1%) had optimal and mean doses for ACEIs of 14.3% and 29.7%. With beta-blockers (72.6%) there was an improvement in doses at 35.4% for the average doses and 3.1%. for the maximum dose. Spironolactone (44.3%) kept the same average dose at 5.7% The median time of optimization was 287.05 days with a median of 140 days. Only 13.4% of patients were receiving optimal treatment at optimal doses. By logistic regression, the presence of LVEF ≤ 0,40 or LVEF= 0.41-0.49 or global heart failure (P < 0.001) favored drug optimization (OR = 24.68[7.15-82.22], P < 0.001); (OR = 11.39[3.25-39.86], P < 0.001) on the other hand, a high serum creatinine level was an obstacle for treatment optimization (OR = 0.92[0.88-0.96], P < 0.001). The optimization of the treatment of heart failure is insufficient with too long delays in our context. The optimization time was so long. It could be improved by setting up a clinic to optimize the treatment of heart failure.

Type 2 Myocardial Infarction in a Sub-Saharan Africa Population: Challenging the Current Concepts-Data From REACTIV.

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. 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. 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.

Tele-ECG improves diagnosis of acute coronary syndrome and ST-elevation myocardial infarction in Côte d'Ivoire.

The emergence of cardiovascular risk factors in sub-Saharan Africa suggests an increasing incidence of acute coronary syndromes and STEMI. The aim of the study was to define the prevalence of STEMI and to describe the characteristics of patients diagnosed with STEMI within the tele-electrocardiogram (ECG) network in Côte d'Ivoire. A retrospective study was conducted from January 2015 to August 2019. All adult patients managed by one of the six hospitals within the telemedicine network who benefited from a remote interpretation of their ECG by the cardiology department of Bouaké University Hospital were included. The main reason for ECG interpretation, patient and ECG characteristics, diagnosis, response time and treatment were described. A total of 5649 patients were included. The prevalence of STEMI was 0.7% (n = 44 cases) with a mean age of 58.6 ± 11.8 years and a M/F sex ratio of 1.93. Among STEMI patients, chest pain was the main reason for ECG testing (56.8%). Most ECGs were interpreted within 12 hours (72.8%). The anterior inter-ventricular artery location (59.1%, n = 26) was predominant. The Q wave of necrosis was absent in 18% (n = 8) of cases. All patients received double anti-platelet aggregation and 50% (n = 22) additional heparin therapy. No patient underwent primary angioplasty or thrombolysis, 65.9% (n = 29) were referred to the Bouaké Cardiology Department and 34.1% (n = 15) to the Abidjan Heart Institute. Scheduled angioplasty was performed in 20% (n = 3) of patients in Abidjan. Tele-ECG was an effective means of STEMI screening in Côte d'Ivoire. Systematic telethrombolysis of all patients diagnosed could improve their prognosis.

Âge vasculaire et risque cardiovasculaire chez les patients hypertendus suivis à l'institut de cardiologie d'Abidjan

ObjectiveTo calculate the vascular age of hypertensive patients and assess the risk at 10 years of occurrence of an absolute cardiovascular event in outpatient consultation of the Abidjan Heart Institute. Patients and methodology: Cross-sectional study with descriptive and analytical purposes from June 2021 to September 2021, i.e. 4 months in patients at least 30 years of age followed in the outpatient department for arterial hypertension without cardiovascular complications. Data were collected using a questionnaire. We considered the parameters established in the D'Agostino chart for the calculation of vascular age. Each parameter was weighted and the total points obtained corresponded to the vascular age. The cardiovascular risk at 10 years was also obtained from another abacus established by D'Agostino by cross-referencing the total points of each patient with pre-established data. ResultsThree hundred hypertensive people were included in this study. The calendar average age was 62.0 ± 10 years with extremes of 30 and 95 years. The gender distribution showed female predominance and there was no significant difference in vascular age by sex. The mean vascular age of all patients was 73.4 ± 9.9 years. The mean difference between actual and vascular age was 11.4 years. Dyslipidemia (p = 0.0002), diabetes (p = 0.0004) and unstandardized BP (p = 0.0000) significantly influenced vascular age. There was no significant difference between smokers and non-smokers (p = 0.1349). All men had a greater than 30% risk of having a cardiovascular accident while women before the age of 35 had no risk. Over the age of 60, almost all patients (both men and women) had a greater than 30% risk of having a cardiovascular accident at 10 years. ConclusionThe calculation of vascular age made it possible to assess arterial aging and calculate the probability at 10 years of occurrence of a cardiovascular event. This study also highlights the importance of cardiovascular risk and vascular age assessment for management adaptation and therapeutic education.

Insuffisance cardiaque aiguë à fraction d’éjection altérée : signes électrocardiographiques associés à la mortalité à l'institut de cardiologie d'Abidjan

IntroductionHeart failure with impaired ejection fraction (HFIEF) represents the end-stage of most cardiac diseases, and is responsible for a high mortality rate. In order to identify patients at risk, numerous clinical and paraclinical prognostic factors have been proposed. The electrocardiogram (ECG), easy to perform and inexpensive, retains a powerful role in the prognostic evaluation of heart failure patients. The aim was to evaluate ECG signs associated with mortality in a retrospective cohort of patients with ICFEA. MethodologyThe study was observational and analytical based on retrospective data collected from patients benefiting from a primary hospitalization for ICFEA at the Abidjan Heart Institute from January 2018 to July 2020. ResultsOf the 370 patients included, 197 had died by August 1, 2020, representing an overall mortality of 53%. Mortality progressed gradually up to one year, then remained unchanged up to 30 months.In multivariate Cox regression including ECG variables only, the presence of intra-ventricular conduction disorders (OR: 1.80; 95% CI [1.01–3.25]), microvoltage (OR: 1.82; 95% CI [1.05–16]), and pathological Q waves (OR: 1.70; 95% CI [1.02–2.83]), were significantly associated with overall mortality. When ECG variables and clinical, paraclinical and therapeutic demographic variables were included, only the presence of pathological Q waves (OR:1.74; 95% CI [1.01–3.01]) persisted as a risk factor for mortality. Hypertension and treatment of heart failure, in particular ACEI/ARII, beta-blockers and ARM, were protective factors. The presence of Q waves was associated with a significant reduction in survival, based on curves obtained using the Kaplan-Meier model. ConclusionICFEA is responsible for high mortality, mainly in the year following the 1st hospitalization for cardiac decompensation. The presence of pathological Q waves is the only electrocardiographic sign that remains statistically associated with a poor prognosis, after adjustment.

Upper Limb Vascular Traumas with Vascular Exposure: Difficulties of Reconstruction in an Isolated Cardiovascular Surgical Environment

Abstract Introduction and Objective: Advocate for the knowledge and development of intrahospital therapeutic management of vascular trauma with vascular exposure, in our working conditions. Materials and Methods: This was a descriptive retrospective study which covered the period from January 2015 to June 2022. It was carried out from the medical records of patients operated on for vascular trauma with exposure of the vessels, in the Cardiovascular Surgery Department at the Abidjan Heart Institute. The following data were studied: epidemiological data, anatomo-clinical characteristics, and therapeutic data. Results: Nine medical records of eight male and one female patient were collected. The average age of the patients was 36 years. Elementary vascular lesions were as follows: complete section of the brachial artery and vein (n = 3), loss of substance of the brachial artery (n = 2), contusion of the brachial artery (n = 1), lateral wound of the ulnar artery (n = 2), and complete section of the radial artery (n = 1). Revascularization consisted in a brachio-brachial arterial bypass using a great saphenous vein graft (n = 3), end-to-end, respectively, arterial and venous anastomosis (n = 3), direct suture of the ulnar artery (n = 2), and in a radio-radial end-to-end arterial anastomosis (n = 1). The covering flaps used were the biceps brachii brachial muscle pedicled flap (n = 6) and the pedicled fasciocutaneous inguinal flap of McGregor (n = 3). The immediate and short-term postoperative follow-up was simple in all patients with scars of good trophicity. Conclusion: The surgical treatment requires skills in plastic surgery for the cardiovascular surgeon or the joint participation, in an emergency, of the cardiovascular surgeon and the plastic surgeon or, if necessary, the management of the patient in two stages. This last therapeutic modality generates additional morbidities and financial cost for the patient.

Évaluation du risque cardiovasculaire chez les patients hypertendus selon le SCORE2 et le SCORE OP dans une population d'Afrique subsaharienne

BackgroundHypertension is a major risk factor for cardiovascular events. The cardiovascular risk assessment is performed using specific algorithms, particularly SCORE2 and SCORE2-OP developed by the European Society of Cardiology. Patients and methodsProspective cohort study from February 1, 2022, to July 31, 2022, enrolling 410 hypertensive patients. Epidemiological, paraclinical, therapeutic, and follow-up data were analyzed. Cardiovascular risk stratification of patients was performed using SCORE2 and SCORE2-OP algorithms. We compared the initial and 6-month cardiovascular risks. ResultsThe mean age of the patients was 60.88 ± 12.35 years with a female predominance (sex ratio = 0.66). In addition to hypertension, dyslipidemia (45.4%) was the most frequently associated risk factor. A high proportion of patients were classified as high (48.6%) and very high (46.3%) cardiovascular risk, with a significant difference between men and women. Reassessment of cardiovascular risk after 6 months of treatment found significant differences compared with the initial cardiovascular risk (p < 0.001). The rate of patients at low to moderate cardiovascular risk (49.5%) increased substantially, whereas the proportion of patients at very high risk decreased (6.8%). ConclusionOur study conducted at Abidjan Heart Institute in a young population of patients with hypertension revealed a severe cardiovascular risk profile. Almost half of the patients are classified at very high cardiovascular risk, based on the SCORE2 and SCORE2-OP. The widespread use of these new algorithms for risk stratification should lead to more aggressive management and prevention strategies for hypertension and associated risk factors.

Characteristics and predictive factors of death in acute coronary syndromes among the elderly: data from the Acute coronary syndrome registry at the Abidjan Heart Institute

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.

Primary Cardiac Tumors Operated on in C&amp;#244;te d’Ivoire: They Are Almost All Myxomas

Objective: Through this surgical series, we present the epidemiological and anatomical-clinical aspects and the surgical results concerning patients operated on for a primary cardiac tumor at the Abidjan Heart Institute. Materials and Method: This is a retrospective descriptive study covering the period of January 1982 to December 2022, based on the medical records of patients operated on for a primary cardiac tumor at the Abidjan Heart Institute. Results: Twenty-seven (27) patients underwent surgery for a primary cardiac tumor, including 14 women and 13 men with a mean age of 41.5 years (range 19 - 76 years). The main circumstances of discovery were exertional dyspnea, palpitation and syncope or pseudo-syncope. The main site was the septal wall of the left atrium. The diagnosis of myxoma was confirmed by pathological examination of the surgical specimen in 96.3% (n = 24) of the patients and it was a malignant large cell immunoblastic lymphoma of the myocardium in 3.7% (n = 1) of the patients. The mean largest diameter was 46.1 mm. The postoperative course was marked by an ischaemic stroke (n = 1); recurrence of a left atrial myxoma 5 years after the first tumor removal (n = 1). Two cases of death were noted, one due to the evolution of immunoblastic large cell lymphoma and the other due to an extracorporeal circulation accident. Conclusion: Almost all primary cardiac tumors operated on in Abidjan are myxomas. The circumstances of the discovery of these cardiac tumors are multiple and varied but dominated by exertional dyspnea, palpitation and syncope. Whatever their histological type, primary cardiac tumors are serious affections, in view of the haemodynamic and rhythmic disorders they cause.

Évolution de l’épidémiologie et de la prise en charge des syndromes coronariens aigus à Abidjan : étude transversale de 1011 patients.

BackgroundTo assess the evolution of the epidemiology and management of patients hospitalized to Abidjan Heart Institute for acute coronary syndrome (ACS). MethodsCross-sectional study comparing two periods: from January 2002 to December 2009 (period 1) and from January 2010 to December 2016 (period 2), including all patients aged 18 years old, admitted to Intensive Care Unit of Abidjan Heart Institute for ACS. ResultsOne thousand eleven (1011) patients were included among the 6784 patients admitted to Intensive Care Unit of Abidjan Heart Institute for a cardiovascular disease. The overall prevalence of ACS was 14.9%. The prevalence in period 2 was significantly higher than in period 1 (22.6% and 7.3% respectively, p < 0.001). Diabetes (33.5%, p < 0.001) significantly, and smoking (30.7%, p = 0.30) had the largest rises from period 1 to period 2. ST-segment Elevation Myocardial Infarction was the main clinical presentation during both periods. The median time to treatment (p = 0.46) and length of hospital stay (p <0.001) decreased during period 2. Percutaneous coronary intervention (PCI) was performed in 173 patients (22.6%) during the period 2 and 42 patients (5.5%) underwent primary PCI. The rate of fibrinolysis increased significantly between the two periods (9.5%, p <0.001). In-hospital death increased during period 2 (10.4%, p = 0.07). ConclusionThe burden of ACS and its related mortality have risen alarmingly past years in Côte d'Ivoire. Healthcare policies should help improve the management and outcomes of patients.

Myocardial infarction with non obstructive coronary arteries (Minoca): Specificities and short-term outcomes in a Sub-Saharan African setting

To describe the characteristics and management of myocardial infarction with non obstructive coronary arteries (MINOCA) at the Abidjan Heart Institute. Observational cross-sectional survey from January 1, 2010 to June 30, 2020 including patients aged > 18 y.o. who underwent coronary angiography for myocardial infarction (MI). Baseline and angiographic data, and short-term outcomes were analyzed and compared between patients with angiographic obstructive coronary artery disease (CAD) and MINOCA. Seven hundred and eighteen patients hospitalized for an acute MI were included over the study period, and 65 (9%) met the definition of MINOCA. Patients with MINOCA were younger with a mean age of 43.2 ± 10 y versus 56.2 ± 10 y. MINOCA patients were more frequently free of classical risk factors ( P = 0.03). MI without ST-segment elevation was more common in MINOCA patients (55.4%; P < 0.0001). Main etiologies in MINOCA were coagulation disorders (6.1%), coronary spasm (6.1%), type I MI with no angiographic obstructive CAD (4.6%), coronary dissection (4.6%) and coronary embolism (3.1%). In 72% of cases, the etiology could not be specified. Complications were observed in 12% of cases and no patient with MINOCA died. MINOCA is a common clinical entity with good outcomes in young patients presenting for an acute MI. Aetiological screening is often challenging in our practice.

English

The aim is to report an Ivorian experience of the surgical management of atrial septal defects in adulthood. Our retrospective study included 19 patients over 18 years old operated on for atrial septal defects (ASD) between January 2005 and December 2015 at the Abidjan Heart Institute (AHI). 13 women and 6 men with a mean age of 26&plusmn;9.07 years were included. For each patient we noted the clinical and para-clinical signs as well as the operative result and the short and long term follow-up data. Patients were symptomatic in 73.7% of cases. Two patients had atrial flutter. On cardiac echo-Doppler, the right ventricle measured 43.5 &plusmn;4.2 mm. The systolic pulmonary artery pressure was 45 &plusmn; 14.7 mmHg. There were 3 cases of grade III tricuspid insufficiency and 1 case of abnormal venous return. Closure of the septal defect was performed with an autologous pericardial patch in 18 cases. Operative mortality was nil. The average length of stay in the surgical intensive care unit was 2.5 days. Eleven patients presented immediate postoperative complications, including 2 cardiac and 9 extracardiac. The total postoperative hospital stay was 14.7 days. After a mean follow-up of 8.25 &plusmn; 4 years, all patients had functional improvement with a significant decrease in right ventricular size and pulmonary arterial pressure. Surgical management of atrial septal defects in adulthood is associated with low mortality with a satisfactory functional outcome. Key words: Atrial septal defect, surgical closure, adult.

Effects of palm oil consumption on lipid and lipoprotein profiles in a group of hypertensive patients at the Abidjan heart institute

Aim: To study the changes in lipid and lipoprotein parameters in a group of hypertensive patients, consuming palm oil or not, at the Abidjan Heart Institute.Methods: We recruited 196 hypertensive patients, which were divided into two groups consumers and non-consumers of palm oil. We analyzed total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol and atherogenic index.Results: Participants' mean age was 57.13 years. Among palm oil consumers, 56.7% had normal cholesterol levels, while 30.8% had high cholesterol levels. In non-palm oil users, cholesterolemia was normal in 56.5% and elevated in 27.2%. Similarly, the serum values of triglycerides, HDL cholesterol, LDL cholesterol and atherogenic index, also showed no significant difference between palm oil consumers and non-consumers.Conclusion: The consumption of palm oil does not significantly influence the lipid and lipoprotein parameters and therefore, has no effect on increasing blood pressure.

Pratique de l’automesure tensionnelle dans une population d’hypertendus en Afrique subsharienne

AimTo investigate home blood pressure monitoring (HBPM) practice among treated hypertensive patients in a subsaharan Africa setting. Patients and methodsCross-sectional observational study over a five-month period from April 30 to September 30, 2019. The survey was carried out among treated hypertensive patients aged at least 18-years-old, received in outpatient consultations department at the Abidjan Heart Institute during the study period. We assessed the rate of patients performing HBPM, and compared characteristics and rate of blood pressure control between patients according to the realization of HBPM. ResultsThree hundred hypertensive patients (mean age 59.2±12.0 years, sex ratio 1.4) were included. Of these, 68.3% reported to have information about HBPM. In 42.3% of cases, patients had an electronic blood pressure device at home, the majority of which were devices with arm cuffs (65.3%). The study showed that 40.3% of the patients had received education on hBPSM, most commonly provided by practitioners (71.9%). Among our population study, 36.3% performed HBPM, of whom only 13.8% according to the 3-day standardised protocol. In multivariate analysis, HBPM appeared to be an independent factor associated with better blood pressure control. ConclusionHBPM is rarely used by patients with hypertension in our practice. Most of the patients do not receive education about HBPM and adequate training in order to perform it routinely.

Caractéristiques et évolution des complications de la stimulation cardiaque dans un centre de cardiologie de l’Afrique de Subsaharienne

Aim of the studyThe working environment and the low rate of pacemaker insertions increase the risk of complications in sub-Saharan Africa. The objective of our work was to assess the impact of specific preventive measures on these complications over the long term. Patient and MethodsWe conducted a retrospective study of all pacemaker implantations from June 2006 to June 2016 at the Abidjan Heart Institute. We evaluated the incidence of pacemaker complications, their risks factors and their impact on the overall prognosis of patients. ResultsThree hundred and two procedures were performed in 286 patients (49% male, mean age: 67±12 years), with a predominance of primary implantation (82.8%) of single-chamber ventricular pacemakers (66.6%). Twenty-five major complications (8.27%) and 14 minor (4.6%) occurred with a predominance of lead displacements (3.64%). The major complications were favored by the subclavian approach (P=0.018; OR=2.34; 95% CI [1.16–4.75]) and intraoperative incidents (P=0.02; OR=2.17; 95% CI [1.16–4.75]. The preventive measures taken made it possible to achieve a significant (P=0.017) and linear (P=0.009) reduction of these complications, with no effect the patients prognosis (Log-Rank=0.217; P=0.64). ConclusionQuality cardiac stimulation is possible in Sub-Saharan Africa with preventive measures adapted to the environment.

Pronostic value of admission hyperglycaemia in Black Africans with acute coronary syndromes: A cross-sectional study

To determine the relationship between acute hyperglycemia and in-hospital mortality in black Africans with acute coronary syndromes (ACS). From January 2002 to December 2017, 1168 patients aged ≥ 18 years-old including 332 patients with diabetes (28.4%) consecutively presented to the intensive care unit of the Abidjan Heart Institute for ACS. Baseline data and outcomes were compared in patients with and without hyperglycemia at admission (> 140 mg/dl). Predictors for death were determined by multivariate logistic regression. The prevalence of admission hyperglycemia was 40.6%. It was higher in patients with diabetes (55.3%). In multivariate logistic regression, acute hyperglycemia (HR = 2.33 [1.44–3.77]; P < 0.001), heart failure (HR = 2.22 [1.38–3.56]; P = 0.001), reduced left ventricular ejection fraction (HR = 6.41 [3.72–11.03]; P < 0.001, sustained ventricular tachycardia or ventricular fibrillation (HR = 3.43 [1.37–8.62]; P = 0.008) and cardiogenic shock (HR = 8.82 [4.38–17.76]; P < 0.001) were predictive factors associated with in-hospital death. In sub-groups analysis according to the history of diabetes, hyperglycemia at admission was predictor for death only in patients without diabetes (HR = 3.12 [1.72–5.68]; P < 0.001). In ACS patients and particularly without history of diabetes, admission acute hyperglycemia is a potential threatening condition. Appropriate management, follow-up and screening for glucose metabolism disorders should be implemented in these patients.

Predictive factors for multi-vessel coronary disease: A single-centre cross-sectional study in côte d’Ivoire

Multi-vessel coronary artery disease (CAD) is recognized as a predictive factor of death in CAD. The aim was to assess the prevalence and predictive factors of multivessel CAD in a catheterization laboratory in Côte d’Ivoire. Over a period of 8 years (April 2010 and January, 2018), we conducted a cross-sectional study in the catheterization laboratory of Abidjan Heart Institute. We enrolled one thousand and nineteen patients (1019) who underwent coronary angiography in the Registre Prospectif des Actes de Cardiologie Interventionnelle de l’Institut de Cardiologie d’Abidjan (REPACI). We analyzed and compared data in patients with and without multivessel CAD. Predictive factors were determined by multivariate logistic regression. Prevalence of multi-vessel CAD was 29.7% (302 patients). Means age was 58 yo with male predominance (87.7%). Main risk factors were hypertension (66.4%), diabetes (34.2%), dyslipidemia (33.9%). Left ventricle systolic dysfunction was reported in 28.9% of patients. Left anterior descending artery was involved in 90.4% of cases. After multivariate logistic regression, age > 50 yo (HR = 1.9; P = 0.02), diabetes (OR = 1.7; P = 0.01), previous percutaneous intervention (PCI) (OR = 2.53; P = 0.0001), chronic renal failure (OR = 4.99; P = 0.01), and type B2/C lesions (OR = 2.12; P = 0.001) were independant predictive factors of multi-vessel CAD. Among the 302 patients with multi-vessel CAD, 81 patients (27%) were eligible for coronary artery bypass graft surgery (CABG) but it was performed in 11 patients only. Multivessel CAD is frequent in our context. Management of these patients in Subsaharan Africa needs heart teams with trained interventional cardiologists and cardiac surgeons, and equipped healthcare facilities.

Prognostic value of admission hyperglycaemia in black Africans with acute coronary syndromes: a cross-sectional study.

The aim of the study was to determine the relationship between acute hyperglycaemia and in-hospital mortality in black Africans with acute coronary syndromes (ACS). From January 2002 to December 2017, 1 168 patients aged ≥ 18 years old, including 332 patients with diabetes (28.4%), consecutively presented to the intensive care unit of the Abidjan Heart Institute for ACS. Baseline data and outcomes were compared in patients with and without hyperglycaemia at admission (> 140 mg/dl; 7.8 mmol/l). Predictors for death were determined by multivariate logistic regression. The prevalence of admission hyperglycaemia was 40.6%. It was higher in patients with diabetes (55.3%). In multivariate logistic regression, acute hyperglycaemia (hazard ratio = 2.33; 1.44-3.77; p < 0.001), heart failure (HR = 2.22; 1.38-3.56; p = 0.001), reduced left ventricular ejection fraction (HR = 6.41; 3.72-11.03; p < 0.001, sustained ventricular tachycardia or ventricular fibrillation (HR = 3.43; 1.37-8.62; p = 0.008) and cardiogenic shock (HR = 8.82; 4.38-17.76; p < 0.001) were predictive factors associated with in-hospital death. In sub-group analysis according to the history of diabetes, hyperglycaemia at admission was a predictor for death only in patients without diabetes (HR = 3.12; 1.72-5.68; p < 0.001). In ACS patients and particularly those without a history of diabetes, admission acute hyperglycaemia was a potentially threatening condition. Appropriate management, follow up and screening for glucose metabolism disorders should be implemented in these patients.

Évaluation des lésions artérielles périphériques chez le coronarien avéré à l’Institut de cardiologie d’Abidjan en Côte d’Ivoire

BackgroundCoronary artery disease is mainly due to atherosclerosis. The aim of this study was to evaluate the frequency of peripheral arterial disease in proven coronary artery disease and to determine the associated factors in our context. Material and methodsWe included in a cross-sectional descriptive and analytical study 224 patients with proven coronary artery disease confirmed on coronary angiography from March 1 to October 30, 2019. It took place in the external exploration department of the Abidjan Heart Institute. An ultrasonographic exploration of the supra-aortic trunks and arteries of the lower extremity with measurement of the ankle brachial index (ABI) was carried out. ResultsThe mean age was 57.4±10.9 years (27–81years). There was a clear male predominance with a sex-ratio of 5. The prevalence of carotid artery disease was 56.4% of patients. The main factors associated with elevated Intima Media Thickness (IMT) and the presence of carotid plaques were male sex (OR=8.8; P=0.038), smoking (OR=2.5; P=0.049) and multi-truncular involvement (OR=3.2; P=0.014). In the lower extremities, there was a prevalence of peripheral arterial disease of 48.5%. The main factors associated with the decrease of ABI were age ≥50 years (OR=2.6; P=0.043), diabetes (OR=2.8; P=0.02), dyslipidemia (OR=3.8; P=0.001) and pluri-truncular involvement (OR=4.5; P<0.0001). ConclusionThe presence of significant coronary artery disease in our context is associated with a high prevalence of peripheral carotid artery and lower extremity artery disease. This is all the more so as we are male, over 50 years old, pluri-truncular with many cardiovascular risk factors.

Primary PCI in the management of STEMI in sub-Saharan Africa: insights from Abidjan Heart Institute catheterisation laboratory.

Implementation of primary percutaneous coronary intervention (PCI) in sub-Saharan Africa remains a challenging issue. The aim of this study was to report the results of primary PCI and outcomes in the catheterisation laboratory of the Abidjan Heart Institute. Between April 2010 and March 2019, all patients aged 18 years presenting to the Abidjan Heart Institute for ST-segment elevation myocardial infarction (STEMI) over the study period and who underwent primary PCI were included. We considered primary PCI when it was performed within 48 hours of the onset of symptoms. Baseline data, PCI characteristics and outcomes were analysed. Among a total of 780 patients hospitalised for STEMI, 471 were admitted within 48 hours of the onset of symptoms. One-hundred and sixty six patients underwent primary PCI, with a ratio of primary PCI/STEMI of up to 21.3%. One hundred and six patients (63.9%) were admitted within 12 hours of the onset of symptoms. The femoral approach was the most commonly used (78.3%). Primary PCI was performed with stent implantation in 84.3% of patients. Drug-eluting stents (DES) were used in 42.1% of patients. In most cases, angiographic success was observed (157/166, 94.6%). Non-fatal complications were mainly haematomas (3.6%). Peri-procedural mortality rate was 1.2%. Primary PCI can be performed safely in some small-volume centres in sub-Saharan Africa. Healthcare policies and regional networks must be encouraged in order to improve management of STEMI patients.