Bertrand E
Faculté de Médecine de Marseille, Hôpital Nord.
Bull Acad Natl Med. 1992 Mar;176(3):311-23; discussion 323-6.
The study of the epidemiological data (published since 1952) seems to show an increasing frequency of the coronary disease for 15 last years. But this incidence seems to reach a stable level about 6 to 7% of the cardiovascular diseases at the Abidjan Institute of Cardiology; and 3.17% in a study in 13 countries but without coronarography (except at the Abidjan Institute). The study of the risk factors show that they are the same ones than in Europa. The risk index in Black Africa was 2.1 to 2.7 risk factor patient. These numbers are lesser than the risk index noted in France (3.6 in coronary patients and 1.9 in non-coronary subjects). The signs of the disease show that myocardial infarctions were frequent (48.8%) and often were the first manifestations of the coronary disease (40%). Angina pectoris was observed in 32.2%, an ischemic cardiomyopathy in 6.6% and a ventricular aneurysm in 6.6%. A silent ischemia was observed in 5.5% among at risk diabetic patients. The in-hospital mortality after myocardial infarction was 15% and was the same in European and African patients. But the mortality in Africans was greater than in Europeans the next years. Coronarography showed that 18.8% of the patients with coronary disease had normal coronary arteries. The arteries were also normal in 19.9% of the patients examined after an infarction. These high percentages can be related to coronary arterial spasms or to recanalized thrombosis. A spontaneous spasm was observed in 6.6% of the patients (a provoked coronary arterial spasm was not studied. The coronary arterial lesion was an one artery disease in 38.8% of the coronary patients and 50% of the patients with infarction. The stenosis were frequently proximal (82.6%) and the anterior descending artery was interested in 45.6%. Ventricular aneurysms were observed in 56.6% and the ejection fraction was lower than 0.50 in 63.3%. These data permit to compare the myocardial infarction of Blacks with the myocardial infarction of the young occidental men. We can think that thrombolysis or angioplasty would be very useful but they are often impossible in the Black African conditions.
对流行病学数据（自1952年以来发表的）研究似乎表明，在过去15年中冠心病发病率呈上升趋势。但在阿比让心脏病学研究所，这一发病率似乎稳定在心血管疾病的6%至7%左右；在一项涉及13个国家的研究中（除阿比让研究所外均未进行冠状动脉造影），该发病率为3.17%。对风险因素的研究表明，这些因素与欧洲的相同。黑非洲的风险指数为每位患者2.1至2.7个风险因素。这些数字低于法国记录的风险指数（冠心病患者为3.6，非冠心病患者为1.9）。该疾病的症状显示，心肌梗死很常见（48.8%），且常常是冠心病的首发表现（40%）。观察到心绞痛的比例为32.2%，缺血性心肌病为6.6%，室壁瘤为6.6%。在有风险的糖尿病患者中，无症状性心肌缺血的比例为5.5%。心肌梗死后的住院死亡率为15%，欧洲和非洲患者相同。但在接下来的几年里，非洲人的死亡率高于欧洲人。冠状动脉造影显示，18.8%的冠心病患者冠状动脉正常。在心肌梗死后接受检查的患者中，19.9%的患者动脉也正常。这些高比例可能与冠状动脉痉挛或再通血栓形成有关。6.6%的患者观察到自发性痉挛（未研究诱发的冠状动脉痉挛）。38.8%的冠心病患者和50%的心肌梗死患者的冠状动脉病变为单支血管病变。狭窄常发生在近端（82.6%），前降支受累比例为45.6%。观察到室壁瘤的比例为56.6%，63.3%的患者射血分数低于0.50。这些数据有助于比较黑人的心肌梗死与西方年轻男性的心肌梗死。我们可以认为溶栓或血管成形术会非常有用，但在黑非洲的条件下往往无法进行。
