[Percutaneous coronary intervention in the management of acute coronary syndromes in Senegal : Challenges and results]. / Angioplastie coronaire dans la prise en charge des syndromes coronariens Aigus au Sénégal : défis et résultats.

INTRODUCTION: Percutaneous coronary intervention (PCI) remains a major therapeutic tool in the management of acute coronary syndromes (ACS). However, it is not widely practiced in sub-Saharan Africa, particularly for the management of ACS. The availability of a catheterization laboratory for 24-hour management of ACS in Dakar is an important step in improving the prognosis of patients. The objective of our study was to evaluate the clinical and prognostic profile of patients presenting an ACS and treated by PCI. PATIENTS AND METHODS: This is a retrospective study that included all patients who underwent PCI for ACS at hospital principal Dakar during the period from January 2019 to December 2020. RESULTS: Our study included 112 patients with a mean age of 60 years (extremes 31-96 years) and a male predominance (sex ratio 4.09). Cardiovascular risk factors were dominated by hypertension (47.3%) and smoking (39.3%). Chest pain was present in 97% of patients. Left ventricular systolic function was impaired in 56 patients with a mean of 50% and extremes of 20 and 78%. Thrombolysis with streptokinase was used in 13 patients with STEMI. The majority of coronary angiogram (95%) were performed between 8 am and 5 pm. The radial route was the most commonly used (85.7%). Double vessel coronary artery disease was predominant (39,3%) and the left anterior descending artery was the most affected (60.7%). The PCI was performed in all patients and in more than half of the cases (55%) within 12 hours of delay. The PCI success rate was 96.4%. Sixty-seven patients (59.8%) underwent balloon predilation. PCI was performed with a drug-eluting stent in the majority of patients (92.8%). The outcome was favorable in 96.4% of the patients, but there were 3 deaths (2.7%). CONCLUSION: Treatment of ACS by PCI is a reality in Senegal with a considerable success rate. However, intervention delays remain one of the major challenges of this management.

Sudden Cardiac Death Following Thrombolysis in a Young Woman with Spontaneous Coronary Artery Dissection: A Case Report.

BACKGROUND Spontaneous coronary artery dissection (SCAD) is a well-known cause of acute coronary syndrome. ST-segment elevation myocardial infarction (STEMI) is the most common presentation of SCAD, which can be complicated by sudden cardiac death (SCD). Conservative management is the cornerstone of treatment except in case of ongoing ischemia or large myocardial compromise. CASE REPORT A 34-year-old woman presented with an anterior STEMI, diagnosed by the Emergency Medical Service (EMS) team, which performed fibrinolysis. SCD resulting from ventricular fibrillation occurred soon after thrombolysis was started. Her pulsed was palpable following defibrillation, and she was immediately intubated. A coronary angiogram (CA) showed total occlusion with dye staining contrast of the proximal left anterior descending (LAD) coronary artery. Echocardiogram showed a severe drop in the left ventricular ejection fraction (LVEF 20%). She was treated with dobutamine and intra-aortic balloon pump implantation because of her poor hemodynamic status. Rescue angioplasty was performed with a drug-eluting stent implanted from the left main stem toward the proximal LAD. However, she developed hemorrhagic shock due to active liver bleeding that was surgically treated. At 3 months, she was asymptomatic, her LVEF had improved (45%), and elective CA showed quite normal coronary arteries. Optical coherence tomography showed residual hematoma as "lunar crescent" and stent under-expansion. The latter was fixed by post-dilatations. CONCLUSIONS Our case adds to the evidence that thrombolysis leads to poor outcomes in patients with SCAD, as reported in numerous reports. OCT was used to confirm, a posteriori, the diagnosis of SCAD. Rescue angioplasty was necessary in our patient due to poor hemodynamic status following unsuccessful fibrinolysis.

Spontaneous coronary artery wall haematoma: success of conservative management despite alarming extension: a case report.

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a particular mode of presentation of acute coronary syndrome. It preferentially affects the young woman with little or no classical risk factor for atheromatous disease. CASE SUMMARY: In this report, we present a classical non-ST-segment myocardial infarction (NSTEMI) condition in link with a spontaneous coronary artery wall haematoma. A 43-year-old female patient who did not have any risk factors for atheromatous disease presented with NSTEMI. The coronary angiogram (CA) revealed a moderate smooth stenosis of the proximal left anterior descending artery (LAD) that ended just before the take-off of a septal branch. Intracoronary imaging by optical coherence tomography (OCT) visualized a large intramural haematoma reducing the coronary artery lumen. The patient was managed conservatively with antithrombotic regimen, nitrates, and close monitoring with repeated CA. Evolution was favourable despite striking extension of coronary haematoma towards distal LAD. She was then discharged and has been asymptomatic on follow-up visits. Planned repeat CA and OCT at 3 months showed a quite normal coronary artery appearance of the LAD with significant regression of haematoma. DISCUSSION: Precise data regarding SCAD epidemiology remains to be determined. The angiographic pattern of our case recalls the Type 2 described by Saw team. But OCT was necessary to confirm the diagnosis. We manage our patient conservatively with close monitoring, as largely suggested by current state of the art, regarding the good haemodynamic status, and absence of ongoing ischaemia despite an evolution severe stenosis.