Introduction: Coronary angioplasty is not widely conducted in sub-Saharan Africa in general and Senegal in particular. The objective of this work was to describe the indications, techniques, results and difficulties of coronary angioplasty in Senegal. Patients and Methods: We prospectively included all patients who underwent coronary angioplasty between July 2012 and November 2014. We evaluated the clinical characteristics, techniques used, and the peri-procedural complications. Results: 110 coronary angioplasties were performed at the cardiac catheterisation unit of the Clinique du Golf in Dakar. The average age of patients was 60.41 ± 10.93 years. A male predominance was noted with a sex ratio of 6.3. Hypertension was found in 57% of patients. The principal indications for coronary angioplasty were for the management of acute coronary syndromes with or without ST elevation, in 29 and 39 patients respectively. The femoral artery was the puncture site in 104 patients. The lesions treated were type A/B1 or B2/C in 53 and 57 cases respectively. The success rates of coronary angioplasties and 30-day mortality were 91% and 0.9% respectively. Conclusion: In sub-Saharan Africa, Senegal in particular, the practice of coronary angioplasty is low. Indeed, many factors linked to socioeconomic status limit the development of coronary angioplasty in Senegal.
Coronary angioplasty with stent implantation introduced by Sigwart et al. in 1986 remains the treatment of choice for coronary atherosclerosis in its various presentations. It is the most common interventional procedure in cardiology with more than 2 million coronary angioplasties done every year worldwide, half of which occur in the United States of America [
The study was carried out at the cardiology department of Hôpital Principal de Dakar and at Clinique du Golf. These two health facilities are both in the Senegalese capital, Dakar.
We prospectively included all patients who underwent coronary angioplasty with or without stent implantation between July 2012 and November 2014. However, patients who underwent only coronary angiography were excluded from the study.
1) Clinical characteristics
We evaluated the patients’ age, sex, modifiable cardiovascular risk factors, history of cardiovascular disease and family history of coronary artery disease.
We analyzed the indications for coronary angioplasty: acute coronary syndrome with or without ST segment elevation, stable angina or silent ischaemia.
2) Interventional procedure
We have also evaluated the following activities done during the procedure: the technique used, the characteristics of the lesion according to the ACC/AHA classification, TIMI flow grade, the catheter and guide wire used, the characteristics of the balloon and stent, the stent type (bare or active), the results of angioplasty (success, intermediate success or failure) and complications.
3) Statistical analysis
The parameters studied were entered onto a computerized questionnaire using Epi Info version 6.0. Statistical analysis was performed using with Statistical Package for the Social Sciences (SPSS) software version 14.0.1. Quantitative variables were expressed as mean ± standard deviation and the qualitative variables were expressed as percentages.
During the study period, 280 coronary angiographies and 110 coronary angioplasties were performed at the Clinique du Golf in Dakar.
1) Clinical characteristics
The average age of patients was 60.41 ± 10.93 years. There was a male predominance with a sex ratio of 6.3 (95 males vs 15 females). Hypertension was the commonest cardiovascular risk factor found in 57% of patients. The prevalence of other risk factors are summarised in
The commonest indications for coronary angioplasty were for the management of acute coronary syndrome, with or without ST segment elevation respectively in 29 and 39 patients. Two patients had a primary angioplasty. The remaining patients were revascularized secondarily after thrombolysis through facilitated angioplasty or after detection of viability respectively in 15 and 12 cases. Other indications for coronary revascularization were effort angina in 38 cases and silent ischemia in 2 patients.
2) Interventional procedure
The femoral artery was the main site of puncture and was used in 104 patients. However, the radial artery was used in 6 patients. The lesions treated were type A/B1 or type B2/C in 53 and 57 cases respectively. A TIMI flow 0 during coronary angiography was present in 23 patients. Five patients had received coronary angioplasty for bifurcation lesion.
The main complications found in our patients were moderate bleeding at the femoral puncture site without hemodynamic consequences but that required transfusion, and one case of acute stent thrombosis. The mortality rate at 30 days was 0.9% (1 patient).
Clinical characteristics | Number | Percentage |
---|---|---|
Average age | 60.41 ± 10.93 | |
Diabetes | 45 | 40.9% |
Smoking | 46 | 41.8% |
Hypertension | 63 | 57.2% |
Dyslipidaemia | 46 | 41.8% |
Family history of coronary artery disease | 10 | 9% |
History of myocardial infarction | 32 | 29% |
History of coronary angioplasty | 11 | 1% |
ST elevation acute coronary syndrome | 29 | 26.3% |
Non-ST elevation acute coronary syndrome | 39 | 35.4% |
Stable angina/silent ischaemia | 42 | 38.% |
Technique for coronary angioplasty | Number | Percentage |
---|---|---|
Femoral artery | 104 | 94.5% |
Radial artery | 6 | 5.5% |
Anterior interventricular artery | 52 | 47.2% |
Circumflex artery | 28 | 25.4% |
Right coronary artery | 27 | 24.5 |
Common trunk | 3 | 2.7% |
Bare stent | 82 | 82.8% |
Drug eluting stent | 17 | 17.2% |
Average length of stent | 17.43 + 4.4 mm | |
Average diameter of stent | 2.9 + 0.2 mm | |
Kissing balloon | 3 | 2.7% |
Volume of contrast | 188.68 + 63.21 ml | |
Success of angioplasty | 100 | 91% |
Coronary angioplasty is an interventional medical procedure widely practised around the world. There are annually more than 2 million angioplasties, with a success rate of 97%, a mortality rate of 0.5%, and a need for urgent coronary surgery of less than 0.5%. Advances in technology and equipments have allowed us to manage more complex lesions such as unprotected common trunk, chronic occlusions and bifurcation lesions. The risk of re-stenosis has been greatly reduced by the use of active stents [
However, the practice of coronary angioplasty is not widespread in sub-Saharan Africa. We describe the first set of coronary angioplasties done in Senegal. This practice is still at a low level, indeed in more than 2 years we have carried out only 110 such procedures or an average of 55 angioplasties per year. This low level of activity is correlated with an excess risk of peri-procedural complications. Ellis et al. [
In sub-Saharan Africa, Senegal in particular, the practice of coronary angioplasty is low. The principal indication in our study was for the management of acute coronary syndromes with or without ST segment elevation. The success rate was high and complications were low. However, many factors linked to low socioeconomic status limit the development of coronary angioplasty in Senegal. The expansion of this activity requires an unwavering government support, the development of coronary surgery and establishment of pharmaceutical industry specializing in interventional cardiology.
The authors declare no conflicts of interest regarding the publication of this paper.
Mboup, M.C., Ba, D.M., Jobe, M., Thiam, M., Dia, K. and Fall, P.D. (2018) Coronary Angioplasty in a Low Income Sub-Saharan Country: Situational Analysis. World Journal of Cardiovascular Diseases, 8, 539-544. https://doi.org/10.4236/wjcd.2018.812053