Key Points
- To systematically assess the epidemiology, clinical presentations, treatment patterns, and outcomes of acute coronary syndrome in sub-Saharan Africa over a 10-year period.
- Systematic search of MEDLINE (PubMed) conducted according to PRISMA guidelines for observational studies published between January 1, 2010, and June 30, 2020.
- Dual, blinded screening evaluated 784 identified articles against standardized acute coronary syndrome diagnostic criteria, yielding 27 eligible observational studies for final review.
- Acute coronary syndrome prevalence ranged from 0.21% to 22.3% among cardiovascular admissions, occurring predominantly in males at younger ages (minimum age 52 years in South Africa and Djibouti), with hypertension present in 50% to 55% of cases.
- Admission delays were common (reaching 4.3 days in Burkina Faso and 6.6 days in Tanzania), and medicalized transport was limited (e.g., 34% total and 8% emergency medical transport in Côte d'Ivoire).
- Revascularization relied largely on fibrinolysis via streptokinase due to scarce percutaneous coronary intervention access; in-hospital mortality spanned 1.2% to 24.5%, and follow-up mortality ranged from 7.8% to 43.3%.
Structured PICO
PPopulationPatients with acute coronary syndrome in sub-Saharan Africa (27 observational studies included)
OOutcomePrevalence, clinical presentation, management, and mortality of acute coronary syndromehard clinical
This systematic review highlights significant disparities in the presentation, management, and outcomes of acute coronary syndrome across sub-Saharan Africa, emphasizing the need for a multicenter registry.