Peripartum Spontaneous Coronary Artery Dissection.

Spontaneous coronary artery dissection is a rare but potentially life-threatening condition that predominantly affects women, particularly during pregnancy or postpartum period. We present a case of peripartum spontaneous coronary artery dissection in a 41-year-old African woman, highlighting the clinical presentation, diagnostic challenges, and management strategies.

[Heart rate recovery and presence of coronary lesions in case of ischemic heart disease at the Abidjan Cardiology Institute in Côte d'Ivoire]. / Fréquence cardiaque de récupération et présence de lésions coronaires au cours des cardiopathies ischémiques à l'Institut de cardiologie d'Abidjan en Côte d'Ivoire.

Introduction: Heart rate recovery (HRR) measured during stress tests, assesses the vago-sympathetic balance. It is a known prognostic and predictive parameter of cardiovascular mortality that is believed to be correlated with the presence and severity of coronary artery disease. The aim of this work was to assess the predictive value of heart rate recovery in the diagnostic and severity of coronary lesions in a major metropolis of sub-Saharan Africa where access to specialist care is unevenly distributed. Patients and method: We conducted a retrospective observational study from January 2010 to February 2020 at the Abidjan Cardiology Institute, including patients who performed a diagnostic coronary angiography after a positive exercise test. Clinical, angiographic and exercise parameters were analyzed and compared in patients with abnormal heart rate recovery (HRR) and those with normal one. Results: The main study limitation is small sampling due to the cost of the angiographic procedure which limits its realization. We recorded 41 subjects whose mean age was 53.4 ± 9.6 years with a male predominance (sex ratio of 3.6). The predominant age group was between 50 and 60 years. Males were older than females with no significant difference. The predominant cardiovascular risk factors were overweight/obesity (68.29%) and hypertension (61%). Eight patients (19.5%) presenting an abnormal HRR (≤12 bpm) had more significant coronary disease (p=0.02) and more severe ones (p=0.003). Patients with abnormal HRR tended to be older without statistical significance (p=0.081), and had lower chronotropic reserve and maximum heart rate (p=0.008 and p=0.042, respectively). The positive predictive value of HHR was 87.5% and its negative predictive value was 60.6%. Conclusion: Abnormal HRR can predict the presence of coronary artery disease and its severity. Evaluating HRR during stress tests could help in the detection, evaluation, and monitoring of ischemic heart disease in our resource-limited countries.

[Characteristics and predictive factors of death in acute coronary syndromes among the elderly: data from the Acute coronary syndrome registry at the Abidjan Heart Institute]. / Caractéristiques et facteurs prédictifs de décès dans les syndromes coronariens aigus du sujet âgé: données du Registre des syndromes coronariens aigus de l'Institut de cardiologie d'Abidjan.

Introduction-Objective: Acute coronary syndromes (ACS) are the leading cause of death among the elderly in sub-Saharan Africa. The aim of this study was to analyze the characteristics of ACS among the elderly at the Abidjan Heart Institute. Materials and methods: Cross-sectional study from January 1, 2015, to December 31, 2019. All patients aged 18 or more admitted to the Abidjan Heart Institute for ACS were included. These patients were divided into two groups: elderly (≥ 65 years old) and non-elderly (< 65 years old). Clinical data, management and outcomes were compared and analyzed in both groups. Results: A total of 570 patients were included, of which 137 (24%) were elderly. Sixty percent (60%) of elderly patients presented with ST Segment Elevation Myocardial Infarction (STEMI). Percutaneous coronary intervention (PCI) was less performed among elderly patients (21.1% vs 30.2%, p = 0.039). Heart failure was the most important complication among the elderly group (56.9% vs 44.6%, p = 0.012). In-hospital mortality was 8% among the elderly. Predictive factors for in-hospital mortality were history of hypertension (HR 2.58; CI95% 1.10-6.08) and STEMI presentation (OR 11.60; CI95% 2.70-49.76). PCI was a protective factor for in-hospital mortality (OR 0.14; IC95% 0.03-0.62). Conclusion: ACS occur with increasing frequency with age. Poor outcomes among the elderly are determined by the clinical presentation and comorbidities. PCI appears to significantly reduce in-hospital mortality.

[Career choice of ivorian medical students at the end of curriculum: influencing factors and aspirations]. / Choix de carrière des étudiants en médecine ivoiriens en fin de cursus : facteurs d'influence et aspirations.

Introduction: The implantation of health structures in Côte d'Ivoire to improve geographical accessibility to care remains unequal between rural and urban areas. The medical student has to decide on his or her career choice in this context, while also taking into account personal preferences. The aim of our study was to evaluate the factors influencing the speciality choice of medical students at the faculty of medicine of Félix Houphouët-Boigny University in Abidjan. Methodology: Medical students enrolled in the 6th year completed an anonymous self-administered questionnaire. The questionnaire was in paper format and was divided into three parts: socio-demographic criteria; speciality choice; and factors influencing career choice. Students were asked to rate the extent to which they perceived each of the 24 items as influencing their career choice using a Likert scale ranging from 1 (no influence) to 5 (strong influence). The factors were compared according to the speciality choice (medical or surgical). Results: The 3 most chosen specialties were: cardiology (17.9%), gynaecology-obstetrics (15.7%) and paediatrics (9.6%). The desire to take the internship competition was more frequent among students who chose a surgical speciality (p = 0.02). The choice of a medical speciality was more influenced by the willingness to work part-time (p = 0.04). Students who choose a medical speciality were more guided by social commitment than those who chose a surgical speciality (p = 0.04). In contrast, the latter were more influenced by prestige among colleagues (p = 0.04) and immediate postoperative outcomes (p = 0.01). Conclusion: The efficient equipment of health structures could contribute to the development of other less chosen specialities by making them more attractive. A reorganisation of the system with the deployment of teachers in regional hospitals with a minimum of equipment is indispensable in order to allow a "decentralization" of the specialization curriculum, especially for the surgical specialties.As for the aspiration to part-time work, it can be explained by the need to reconcile family and professional life, but also by a sometimes unspoken project to develop a lucrative extra-medical activity in order to make up insufficient wages.

Acute Coronary Syndromes in Sub-Saharan Africa: A 10-Year Systematic Review.

Background Data in the literature on acute coronary syndrome in sub-Saharan Africa are scarce. Methods and Results We conducted a systematic review of the MEDLINE (PubMed) database of observational studies of acute coronary syndrome in sub-Saharan Africa from January 1, 2010 to June 30, 2020. Acute coronary syndrome was defined according to current definitions. Abstracts and then the full texts of the selected articles were independently screened by 2 blinded investigators. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. We identified 784 articles with our research strategy, and 27 were taken into account for the final analysis. Ten studies report a prevalence of acute coronary syndrome among patients admitted for cardiovascular disease ranging from 0.21% to 22.3%. Patients were younger, with a minimum age of 52 years in South Africa and Djibouti. There was a significant male predominance. Hypertension was the main risk factor (50%-55% of cases). Time to admission tended to be long, with the longest times in Tanzania (6.6 days) and Burkina Faso (4.3 days). Very few patients were admitted by medicalized transport, particularly in Côte d'Ivoire (only 34% including 8% by emergency medical service). The clinical presentation is dominated by ST-elevation sudden cardiac arrest. Percutaneous coronary intervention is not widely available but was performed in South Africa, Kenya, Côte d'Ivoire, Sudan, and Mauritania. Fibrinolysis was the most accessible means of revascularization, with streptokinase as the molecule of choice. Hospital mortality was highly variable between 1.2% and 24.5% depending on the study populations and the revascularization procedures performed. Mortality at follow-up varied from 7.8% to 43.3%. Some studies identified factors predictive of mortality. Conclusions The significant disparities in our results underscore the need for a multicenter registry for acute coronary syndrome in sub-Saharan Africa in order to develop consensus-based strategies, propose and evaluate tailored interventions, and identify prognostic factors.

[Levine's sign in the diagnosis of acute coronary syndrome with non-contributory electrocardiogram: About one case at the Abidjan Cardiology Institute (Ivory Coast)]. / Signe de levine dans le diagnostic du syndrome coronarien aigu avec electrocardiogramme non contributif : A propos d'un cas a l'Institut de Cardiologie d'Abidjan (Cote d'Ivoire).

Acute chest pain is usually expressed in typical language; which is sometimes assigned a particular sign. One of the signs is that of Levine, usuallytranslating a coronary involvement. This clinical case highlights a patient who is admitted for chest pain with Levine's sign and a non-contributory electrocardiogram. Biological and coronarographic explorations carried out for this purpose revealed occlusion of the proximal right coronary artery by thrombosis, successfully revascularized. This observation highlights the place of the interrogation in the assessment of any patient.

La douleur thoracique aiguë s'exprime généralement dans un langage typique; qui se voit parfois attribuer un signe particulier. Un des signes est celui de Levine, traduisant en général une atteinte coronarienne. Ce présent cas clinique met en évidence un patient qui est admis pour une douleur thoracique avec des caractères du signe de Levine et un électrocardiogramme non contributif. Les explorations biologique et coronarographique réalisées à cet effet ont permis de mettre en évidence une occlusion de l'artère coronaire droite proximale par thrombose, revascularisée avec succès.Cette observation met en lumière la place de l'interrogatoire dans l'évaluation de tout patient.

Profil pharmaco-doppler pénien des patients coronariens souffrant de dysfonction érectile à l'Institut de Cardiologie d'Abidjan une série de 30 cas / Penile pharmaco doppler profile of coronary patients with erectile dysfunction at the Abidjan Cardiology Institute: a series of 30 cases

Contexte et objectif. La maladie athéromateuse dont la coronaropathie étant une pathologie diffuse peut être prévenue par le contrôle des facteurs de risqué cardiovasculaire. Le but de cette étude était de décrire les caractéristiques pharmaco doppler pénien des patients coronariens souffrant de dysfonction érectile. Méthodes. Il s'agissait d'une série analytique des cas suivie entre juin 2020 et février 2021. Elle concernait des patients ayant des lésions athéromateuses significatives à la coronographie et souffrant de dysfonction érectile. Nous avons évalué les caractéristiques pharmaco doppler pénien. La qualité d'érection était appréciée par le score de rigidité Erectile Hardness Score (EHS). Résultats. Trente-six patients étaient inclus. L'âge moyen était de 56 ± 8,4 ans. le pic de Vitesse systolique au repos (PSVr) moyen des patients était de 13,7 cm/s ± 5,9. Le pic de vitesse systolique post injection (PSV pi) moyen des patients était de 23,9 cm/s ± 5,4. Les causes étaient principalement artérielles de 75%. La qualité d'érection était appréciée selon le score EHS : E1 (83%), E2 (22%), E3 (5%) et E4 (3%). Conclusion. La dysfunction érectile est associée aux facteurs de risque cardiovasculaire selon plusieurs études. L'echodoppler pénien avait occupé une place importante dans le diagnostic étiologique. Les causes retrouvées étaient principalement artérielles avec une baisse de PSVpi<25 cm/s.

Prognostic value of admission hyperglycaemia in black Africans with acute coronary syndromes: a cross-sectional study.

AIM: The aim of the study was to determine the relationship between acute hyperglycaemia and in-hospital mortality in black Africans with acute coronary syndromes (ACS). METHODS: From January 2002 to December 2017, 1 168 patients aged ≥ 18 years old, including 332 patients with diabetes (28.4%), consecutively presented to the intensive care unit of the Abidjan Heart Institute for ACS. Baseline data and outcomes were compared in patients with and without hyperglycaemia at admission (> 140 mg/dl; 7.8 mmol/l). Predictors for death were determined by multivariate logistic regression. RESULTS: The prevalence of admission hyperglycaemia was 40.6%. It was higher in patients with diabetes (55.3%). In multivariate logistic regression, acute hyperglycaemia (hazard ratio = 2.33; 1.44-3.77; p < 0.001), heart failure (HR = 2.22; 1.38-3.56; p = 0.001), reduced left ventricular ejection fraction (HR = 6.41; 3.72-11.03; p < 0.001, sustained ventricular tachycardia or ventricular fibrillation (HR = 3.43; 1.37-8.62; p = 0.008) and cardiogenic shock (HR = 8.82; 4.38-17.76; p < 0.001) were predictive factors associated with in-hospital death. In sub-group analysis according to the history of diabetes, hyperglycaemia at admission was a predictor for death only in patients without diabetes (HR = 3.12; 1.72-5.68; p < 0.001). CONCLUSIONS: In ACS patients and particularly those without a history of diabetes, admission acute hyperglycaemia was a potentially threatening condition. Appropriate management, follow up and screening for glucose metabolism disorders should be implemented in these patients.

Primary PCI in the management of STEMI in sub-Saharan Africa: insights from Abidjan Heart Institute catheterisation laboratory.

BACKGROUND: Implementation of primary percutaneous coronary intervention (PCI) in sub-Saharan Africa remains a challenging issue. The aim of this study was to report the results of primary PCI and outcomes in the catheterisation laboratory of the Abidjan Heart Institute. METHODS: Between April 2010 and March 2019, all patients aged 18 years presenting to the Abidjan Heart Institute for ST-segment elevation myocardial infarction (STEMI) over the study period and who underwent primary PCI were included. We considered primary PCI when it was performed within 48 hours of the onset of symptoms. Baseline data, PCI characteristics and outcomes were analysed. RESULTS: Among a total of 780 patients hospitalised for STEMI, 471 were admitted within 48 hours of the onset of symptoms. One-hundred and sixty six patients underwent primary PCI, with a ratio of primary PCI/STEMI of up to 21.3%. One hundred and six patients (63.9%) were admitted within 12 hours of the onset of symptoms. The femoral approach was the most commonly used (78.3%). Primary PCI was performed with stent implantation in 84.3% of patients. Drug-eluting stents (DES) were used in 42.1% of patients. In most cases, angiographic success was observed (157/166, 94.6%). Non-fatal complications were mainly haematomas (3.6%). Peri-procedural mortality rate was 1.2%. CONCLUSIONS: Primary PCI can be performed safely in some small-volume centres in sub-Saharan Africa. Healthcare policies and regional networks must be encouraged in order to improve management of STEMI patients.

[Coronary lesions in black African patients with acute coronary syndromes]. / Lésions coronaires chez le noir africain dans les syndromes coronariens aigus.

INTRODUCTION: acute coronary syndromes (ACSs) have been increasing in sub-Saharan Africa. Coronary angiography data have been rarely reported. This study aims to investigate coronary lesions observed in patients with acute coronary syndromes (ACS) in Abidjan. METHODS: we conducted a cross-sectional study from 1st January 2010 to 31st December 2014. All patients with ACS admitted to the Abidjan Heart Institute and undergoing coronary angiography during the study period were included. Two hundred and fifty-six patients were selected. We investigated and compared coronary lesions in patients with ACS associated with persistent ST-segment elevation (ACS ST+) and in those with ACS without ST-segment elevation (ACS ST-). RESULTS: the average age of patients was 53.2 ± 10.8 years; there was a male predominance, with a sex ratio of 6.1. Abnormal coronary angiography rate was significantly higher in the STEMI group (95.4% and 64.2% respectively, p < 0.001). Three hundred and four coronary lesions were found in the STEMI group against 43 in the NSTE-ACS group. Stenotic lesions were predominantly one-vessel disease (45.3%) in the STEMI group and two or three-vessel disease in the NSTE-ACS group (68.0%). Type B1 lesions were more common in the NSTE-ACS group (62.8% versus 36.5%, p = 0.002). The most complex type C lesions were more commonly found in the STEMI group (17.8%), with no significant difference. The majority of patients had SYNTAX score less than 22, whatever the type of ACS (87.4% in the STEMI group and 90.1% in the NSTE-ACS group). CONCLUSION: coronary lesions in the patients group with STEMI were predominantly one-vessel disease and they were more diffuse in the NSTE-ACS group, but with a higher proportion of angiographically normal coronary arteries. The management of patients with these lesions is based in the majority of cases on coronary angioplasty.

Coronary angiographic findings in dilated cardiomyopathy in a sub-Saharan African population.

AIM: To describe the coronary angiographic aspects observed in patients with dilated cardiomyopathies (DCM) in a sub-Saharan African country in order to improve their management. METHODS: This was a cross-sectional study conducted from 1 January 2010 to 31 March 2016. All patients aged 18 years and older, presenting with DCM and admitted to Abidjan Heart Institute, who underwent coronary angiography were included. One hundred and eight patients were selected. We analysed and compared the coronary angiographic features observed. RESULTS: The median age of our patients was 52 years (46-61). There was a male predominance (sex ratio = 3). Hypertension (53.7%) was the major cardiovascular risk factor found. Coronary angiography was abnormal in 37 patients (34.3%). Twenty-three patients (21.3%) had obstructive coronary artery disease (CAD). Patients with CAD were older than those with normal coronary arteries, but with no statistically significant difference (p = 0.06). Hypertension (p < 0.001) and diabetes (p = 0.0003) were statistically significantly more commonly reported in patients with CAD. CONCLUSIONS: Ischaemic heart disease is likely to be underdiagnosed in sub-Saharan Africa. A coronary angiographic assessment of patients receiving treatment for DCM, especially in the presence of cardiovascular risk factors, should help optimise their management and improve prognosis.

Medium and long-term follow-up after ST-segment elevation myocardial infarction in a sub-Saharan Africa population: a prospective cohort study.

BACKGROUND: Major in-hospital mortality rate in patients with ST-segment Elevation Myocardial Infarction (STEMI) in Sub-Saharan Africa has been reported. Data on follow-up in these patients with STEMI are scarce. We aimed to assess medium and long-term prognosis in patients with STEMI admitted to Abidjan Heart Institute. METHODS: Prospective cohort study including 260 patients admitted for STEMI to Abidjan Heart Institute, from January 1, 2012 to December 31, 2015. We compared mortality and nonfatal cardiovascular complications in revascularized and non-revascularized groups. Survival curve was generated with the Kaplan-Meier method. Predictors of mortality after STEMI were determined by multivariable Cox regression. RESULTS: Of the 260 patients followed up on a median period of 39 months [28-68 months], 94 patients (36.1%) were revascularized and 166 (63.8%) were non-revascularized. Crude all-cause mortality was 10.4%. It was significantly higher in non-revascularized patients (p = 0.04). There was no difference in the occurrence of nonfatal cardiovascular complications in the 2 groups. In multivariable Cox regression, age ≥ 70 years, female gender and heart failure were the predictive factors for death after adjustment. CONCLUSIONS: STEMI remains an important cause of mortality in our practice. Healthcare policies should be developed to improve patient care and long-term outcomes.

Coronary artery disease in black African patients with diabetes: Insights from an Ivorian cardiac catheterization centre.

BACKGROUND: Coronary angiography data are scarce for black patients with diabetes. AIM: To assess coronary angiography findings in patients with diabetes at the Abidjan Heart Institute. METHODS: This observational cross-sectional survey was conducted between 1 April 2010 and 31 December 2014. All patients admitted for known or suspected coronary artery disease who underwent coronary angiography were included in the Registre Prospectif des Actes de Cardiologie Interventionnelle de l'Institut de Cardiologie d'Abidjan. We analysed and compared coronary angiographical findings in patients with and without diabetes. RESULTS: Eighty patients with diabetes were compared with 353 patients without diabetes. Patients with diabetes were significantly older (58.7±8.9 vs 52.1±11.5 years; P<0.001). Hypertension and hypertriglyceridaemia were significantly associated with diabetes (P<0.001 and P=0.04, respectively). A higher proportion of patients with diabetes had an abnormal coronary angiogram (85.0% vs 67.7%; P=0.002). Coronary artery disease in patients with diabetes was predominantly characterized by multivessel disease (P<0.001). Cardiovascular risk factors associated with diabetes influenced the severity of coronary lesions. A SYNTAX score≥33 was found in a higher proportion of patients with diabetes (12.5% vs 7.1%). In the multivariable logistic regression, after adjustment, age>60 years (hazard ratio 2.53, 95% confidence interval 1.59-4.04; P<0.001) and diabetes (hazard ratio 2.12, 95% confidence interval 1.26-3.57; P=0.004) were associated with multivessel coronary artery disease. CONCLUSIONS: In our study, diabetes emerged as a risk factor for multivessel coronary artery disease. Future studies should help to define the long-term prognosis of these patients, and to assess the benefits of myocardial revascularization procedures.