Varwani Mohamed Hasham, Jeilan Mohamed, Ngunga Mzee, Barasa Anders
Department of Medicine, the Aga Khan University Hospital, Nairobi, Kenya. Email:
Department of Medicine, the Aga Khan University Hospital, Nairobi, Kenya.
Cardiovasc J Afr. 2019;30(1):29-33. doi: 10.5830/CVJA-2018-066. Epub 2018 Dec 4.
Coronary artery disease and its acute presentation are being increasingly recognised and treated in sub-Saharan Africa. It is just over a decade since the introduction of interventional cardiology for coronary artery disease in Kenya. Local and regional data, and indeed data from sub-Saharan Africa on long-term outcomes of acute coronary syndromes (ACS) are lacking.
A retrospective review of all ACS admissions to the Aga Khan University Hospital, Nairobi (AKUHN) between January 2012 and December 2013 was carried out to obtain data on patient characteristics, treatment and in-patient outcomes. Patient interviews and a review of clinic records were conducted to determine long-term mortality rates and major adverse cardiovascular events.
A total of 230 patients were included in the analysis; 101 had a diagnosis of ST-segment myocardial infarction (STEMI), 93 suffered a non-ST-segment myocardial infarction (NSTEMI), and 36 had unstable angina (UA). The mean age was 60.5 years with 81.7% being male. Delayed presentation (more than six hours after symptom onset) was common, accounting for 66.1% of patients. Coronary angiography was performed in 85.2% of the patients. In-hospital mortality rate was 7.8% [14.9% for STEMI and 2.3% for non-ST-segment ACS (NSTE-ACS, consisting of NSTEMI and UA)], and the mortality rates at 30 days and one year were 7.8 and 13.9%, respectively. Heart failure occurred in 40.4% of STEMI and 16.3% of NSTE-ACS patients. Re-admission rate due to recurrent myocardial infarction, stroke or bleeding at one year was 6.6%.
In our series, the in-hospital, 30-day and one-year mortality rates following ACS remain high, particularly for STEMI patients. Delayed presentation to hospital following symptom onset is a major concern.
在撒哈拉以南非洲地区，冠状动脉疾病及其急性发作越来越受到重视并得到治疗。肯尼亚引入冠状动脉疾病介入心脏病学至今刚过去十多年。目前缺乏当地和地区性数据，实际上也缺乏来自撒哈拉以南非洲地区关于急性冠状动脉综合征（ACS）长期预后的数据。
对2012年1月至2013年12月期间内罗毕阿迦汗大学医院（AKUHN）所有ACS住院患者进行回顾性研究，以获取患者特征、治疗及住院结局的数据。通过患者访谈和查阅临床记录来确定长期死亡率和主要不良心血管事件。
共有230例患者纳入分析；101例诊断为ST段抬高型心肌梗死（STEMI），93例为非ST段抬高型心肌梗死（NSTEMI），36例为不稳定型心绞痛（UA）。平均年龄为60.5岁，男性占81.7%。症状出现后延迟就诊（超过6小时）很常见，占患者的66.1%。85.2%的患者接受了冠状动脉造影。住院死亡率为7.8%[STEMI为14.9%，非ST段ACS（NSTE-ACS，包括NSTEMI和UA）为2.3%]，30天和1年的死亡率分别为7.8%和13.9%。STEMI患者中有40.4%发生心力衰竭，NSTE-ACS患者中有16.3%发生心力衰竭。1年时因复发性心肌梗死、中风或出血再次入院率为6.6%。
在我们的系列研究中，ACS后的住院死亡率、30天和1年死亡率仍然很高，尤其是STEMI患者。症状出现后延迟就医是一个主要问题。
