Acute Coronary Syndromes in Niger: (West Africa): Epidemiological, Clinical, Para clinical and Therapeutic Aspects

Abstract

Introduction: Coronary artery disease is the leader in cardiovascular disease. An estimated 7.5 million deaths from cardiovascular disease are due to coronary heart disease. WHO estimates that by 2030, nearly 23.6 million people will die from cardiovascular disease? Over 80% of deaths attributed to cardiovascular disease occur in low- and middle-income developing countries. The CORONAFRIC survey done in 1991 and which gathered 13 West African countries with 16 centers found a prevalence of coronary heart disease of 3, 17%. In Niger an over survey done in 2013 shows a prevalence of coronary heart disease at 5.60%. The main cause of coronary pathologies is atherosclerosis or atheroma and its sudden complication thrombosis. This review aims to study the local specificities of ACS through its epidemiological, clinical, Para clinical and therapeutic aspects at the level of the LAMORDE National Teaching Hospital (LNTH), in the absence of a cardiology technical platform intervention and in the absence of pre-hospital care, in order to formulate recommendations for the prevention of coronary artery diseases in low income countries. Patients and Methods: This is a retro and prospective study over a period (July 01, 2014 to December 31, 2019) of 66 months and concerns cases of ACS hospitalized in the internal medicine and cardiology department of LNTH. Were included in our study patients with angina pain, and electrocardiographic signs (ischemia, lesion or necrosis) with or without a confirmed past history of MI but admitted with biological signs. Results: At the end of our study, the prevalence of ACS is 10.67% compared to cardiovascular disease, CI 51.24%, stroke 26.24% and thromboembolic disease 2.84%. ACS is predominantly male in 63.77% of cases. The sex ratio is 1.76 -the age ≥50 years represents 86.98% of the subjects, with an average age of 60.98 years; -The months of November, December, January and February represent the favorable period for the onset of acute coronary syndromes with 23.20% of cases. - Retro sternal chest pain is by far the most common symptom with 67.63% of cases. Troponin was measured in 75 of our patients, ie 36.23% of which 35.27% had a high level.- ECG, troponin allowed us to identify forms of ACS with 70.05% of ACS ST +; 21.74% unstable angina and 8.21% Q- wave of MI. - The most affected territory was anterior with 153 cases (73.91%) followed by the lower territory 46 cases (22.22%) then the lateral territory 16 cases (7.73%) associated. In our study, hypertension was encountered in 34.48% of cases, diabetes (11.11%), hypercholesterolemia 4.35%), smoking (with 4.83%), obesity (with 2.90%), menopause (with 84.93%) were recognized as risk factors favoring the occurrence of ACS. In 96.14% of the cases, the patients were put on aspirin and clopidogrel followed by the ICE in 93.24% of the cases; Beta blocking in 92.75% of cases; statin in 89.86% of cases; of diuretics in 55.56% of cases and heparin in 52.17% of cases. In our study, 80.68% of our patients left hospital after clinical improvement. We have a high mortality rate of 19.32%. 80% of patients had HF as a complication, and conduction disorders are noted in 16% of cases and recurrence of pain in 8% of patients.