Invasive Coronary Angiography and Interventions in Sub-Saharan West Africa: An Insight from Cardiovascular Education Foundation Program

Abstract

Africa STEMI Conference Nairobi 2024

Presenters : Oladipupo Olafiranye,1,2, Oluwaseye Michael Oladimeji3, Oluwaseyi Bolorunduro4, Uzoma Ibebuogu5, Obinnaya Emerole6, Tayo Addo1

1. Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA

2. Department of Medicine, Division of Cardiology, Veterans Affairs North Texas Health Care System, Dallas, TX, USA

3. Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria.

4. NOVA Cardiovascular Care, INOVA Fairfax Hospital, Fairfax, VA, USA.

5. Department of Medicine, Division of Cardiology, University of Tennessee Health Science Center, Memphis, TN, USA.

6. Department of Medicine, Division of Cardiology, Atrium Health Navicent, Macon, GA, USA.

Background

Advanced invasive coronary angiography (CA) and percutaneous coronary interventions (PCI) are limited in Sub-Saharan West Africa due to limited resources and procedural expertise. We report on the use of invasive CA and PCI in the management of patients with suspected coronary artery disease (CAD) in Sub-Saharan West Africa through a charitable and educational program supported by visiting United States interventional cardiologists.

Methods

A retrospective analysis of patients that underwent invasive coronary angiography facilitated by charitable contributions from Cardiovascular Education Foundation and visiting United States interventional cardiologists at 4 facilities with limited resources and capabilities in Nigeria between 2018 and 2023.

Results

A total of 171 patients (mean age 60 ± 10 years, 30% females) underwent CA. The indications for CA were recent ST elevation myocardial infarction in 10% (17/171), non-STEMI in 10% (17/171), unstable angina in 42% (71/171), and chronic coronary syndromes (CCS) in 37% (66/173). Approximately 95% of the cohort had hypertension, while 84% and 36% had dyslipidemia and diabetes respectively. Heart failure with reduced ejection fraction was present in 36%. Invasive CA revealed severe obstructive CAD in 76% of patients with acute coronary syndrome and 22% of those with CCS. Among those with obstructive CAD, the rates of left main stenosis and multivessel disease were 5% and 38% respectively. PCI was performed in 82 patients, 9 of which were chronic total occlusions, while 29 were multivessel interventions. A total of 13 patients were referred for coronary artery bypass graft. Major adverse periprocedural events occurred in 2 out of 171 (1.2%) patients.

Conclusions

Invasive coronary angiography and interventions are feasible and safe in low-resource facilities in Sub-Saharan West Africa aided by charity and expertise of visiting trained interventional cardiologists. Development of interventional cardiology training programs in this region is advocated.