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Research Article | DOI: https://doi.org/10.31579/2641-0419/437
1Cardiology department – Idrissa Pouye Hospital.
2Cardiology department – Hospital CHNU Fann.
3Cardiology department – Dakar army training hospital.
4Cardiology department – Dalal Jamm Hospital.
5Cardiology department – Dantec Hospital.
*Corresponding Author: Momar Dioum, Cardiology department – Hospital CHNU Fann.
Citation: Momar Dioum, Papa Guirane Ndiaye, Pape M.D. Fall, Joseph S Mingou, Cheikh T Ndao, et al, (2025), Stemi in Dakar Registry: Evaluation of Data at 06 Months, J Clinical Cardiology and Cardiovascular Interventions, 8(1); DOI: 10.31579/2641-0419/437
Copyright: © 2025, Momar Dioum. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 02 December 2024 | Accepted: 27 December 2024 | Published: 10 January 2025
Keywords: acute coronary syndrome; stemi-dakar registry; treatmentV
Introduction: ST-elevation myocardial infarction (STEMI) remains a worldwide scourge with dramatic consequences both functionally and prognostically. In Senegal, since 2014, enormous progress has been made to improve the management of this disease. However, some challenges remain. The overall objective of this study was to assess the overall management of patients with STEMI.
Methodology: This is a prospective, descriptive and analytical study over a period of 06 months from April 1st, 2023 to September 31th, 2023. All patients admitted to the four major cardiology departments in Dakar for STEMI were included. The socio-demographic, diagnostic, therapeutic and evolutionary parameters were studied. We entered the data with the Kobotoolbox software and analyzed the results using the SPSS software. The threshold of significance was a value of p < 0.05.
Results: We included 157 patients, the hospital prevalence was 11.7%. The sex ratio H/F was 2.48. The mean age of patients was 58 years. The average time between onset of pain and first medical contact (FMC) was 10.57 hours. The proportion of patients received before the first 12 hours was 79.6%. The coronary angiography rate was 66.5% and it was abnormal for 96.3%. It was predominantly one-vessel coronary artery disease (51%). The rate of completion of primary percutaneous coronary intervention (PCI) was 24.2%. Thrombolysis was performed in 32.5% of patients with a success rate of 49%. Hospital mortality was 10.8% or 17 patients. The factors of poor prognosis identified were: number of medical facilities consulted before admission to cardiology (p value = 0.04), presence of conductive disorders (p value = 0.006) and absence of PCI (p value = 0.04).
Conclusion: STEMI is on the rise in our country. Diagnostic delays remain long. The management is suboptimal and sometimes dramatic consequences.
ST-elevation myocardial infarction (STEMI) remains a worldwide scourge with dramatic consequences both functionally and prognostically. It is a disease that is clearly on the increase in Africa and particularly in sub-Saharan Africa [1-2-3]. Enormous progress has been made in these countries, particularly in Senegal, to improve the diagnosis and management of this disease. However, some difficulties remain: significant delays in diagnosis, lack of a real care system, insufficient use of interventional revascularization techniques due to lack of qualified or inadequate medical personnel and an adequate or deficient technical facilities [4-5-6]. The objective of this study was to establish a STEMI registry in Dakar to assess all diagnostic, therapeutic and evolutionary aspects.
Our work was carried out in the four major cardiological services of Dakar including the National University Hospital of Fann, the Hospital Principal of Dakar, the hospital Dalal Jamm of Guediawaye and the General Hospital Idrissa Pouye of Dakar.
This is a cross-sectional, multicentre, prospective, descriptive and analytical study over a period of 06 months (from April 1th, 2023 to September 30th, 2023).
All patients treated for STEMI in these cardiology departments during the study period were included in this study. The diagnosis of STEMI was based on clinical evidence (pain and its equivalents) and changes in the electrocardiogram (ECG) with persistent ST-segment elevation.
The parameters studied were socio-demographic data, history and cardiovascular risk factors. The clinical presentation of the patient, diagnostic delays and admission modes were recorded. At the echocardiography, we looked for segmental kinetics disorders and evaluated the left ventricular systolic function. Coronarography was used to assess the coronary lesion and vessel status [7]. The treatments received in the pre-hospital and hospital phases (thrombolysis, revascularization by PCI or coronary artery bypass grafting CABG and other treatments received). The evolutionary data were also observed.
The collection of all patients was carried out in a registry: The «REGISTRY DAKAR-STEMI» using the software KoboToolbox. Patient data was collected on survey sheets and entered into the software. Data analysis was performed by SPSS software. The threshold of significance was set at a value of p < 0>
The total number of patients included in this registry was 157 out of a total of 1 340 hospitalized patients in these services during the period, representing a hospital prevalence of 11.7%. Mean age of patients was 58.3 ± 12.3 years, with extremes of 24 and 90 years. The largest age group was 55-65, accounting for 34.3% of the population. Male predominance (71.3%) and sex ratio was 2.49. Most patients lived in Dakar and its suburbs (70.8%). Financial coverage was at the patient’s expense in 79% of cases. Only 11% of patients were covered. Patients were referred in 95% of cases. The ambulance was the most used method of transfer in 84.7% of cases and it was mainly medically used in 67.7% of cases. For 14.3% of the patients, the transfer was done with the means of the board (taxi or personal cars). The average number of facilities consulted before admission to cardiology was 2 with extremes of 1 and 4. More than half, 64.7% of patients had consulted at least two health facilities before receiving an accurate diagnosis. The admission schedule of patients was mainly between 08H-20H in 68.2% of cases. Cardiovascular risk factors were dominated by physical inactivity (72.6%), followed by hypertension (47.1%) and diabetes (28.7%). The clinical presentation of patients was dominated by chest pain which was present in almost all patients (156 patients, or 99%). It was typical in 89.9% of the cases. Four patients (2.5%) were admitted after a recovered cardio-respiratory arrest.
The mean time between pain onset and first medical contact (PMC) was 10.57 hours [30 min - 144 h] with a significant proportion of patients (79.6%) admitted within 12 hours after pain onset. The different patient diagnostic delays are summarized in Table I.
| Diagnostic delays | Hourly average |
| Onset of pain and FMC (H) | 10.57 hours [0.5H-144H] |
| FMC and first ECG realization (min) | 129.23 [2 min - 6,912 min] |
| Time to admission in cardiology (H) | 35.78 H [1H - 144 H] |
| Delay in coronary admission (H) | 45.34 H [2 H – 432 H] |
FMC : First Medical Contact
Table I: Patient Delay Characteristics
The number of patients who had a coronary angiography was 101, or 64.3
The STEMI, long considered rare in Africa, has become an African scourge with the latest known developments. It affects the middle-aged adult population with several cardiovascular risk factors. Diagnostic delays remain long. The management is suboptimal, sometimes with dramatic consequences, hence the need to set up a chain of management for coronary patients.
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