Registry for Acute Coronary Events in Nigeria (RACE-Nigeria): Clinical Characterization, Management, and Outcome

Background Coronary artery disease was hitherto a rarity in Africa. Acute coronary syndrome (ACS) accounts for coronary artery disease-related morbidity and mortality. Reports on ACS in Africa are few. Methods and Results We enrolled 1072 indigenous Nigerian people 59.2±12.4 years old (men, 66.8%) w...

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Published in:	Journal of the American Heart Association Vol. 11; no. 1; p. e020244
Main Authors:	Isezuo, Simeon, Sani, Mahmoud Umar, Talle, Abdullahi, Johnson, Adeyemi, Adeoye, Abiodun-Moshood, Ulgen, Mehmet S, Mbakwem, Amam, Ogah, Okechukwu, Edafe, Emmanuel, Kolo, Philip, Nagabea, Murtala, Adebayo, Rasaaq, Nwafor, Eze, Daniel, Folasade, Zagga, Muiyawa, Umar, Hayatu, Oboirien, Isa, Sulaiman, Balarabe A, Abdullahi, Umar, Mijinyawa, Muhammad Sani, Buba, Farouk, Aje, Akinyemi, Okolie, Henry, Shehu, Muhammad Nazir, Adamu, Umar, Olusegun-Joseph, Akinsanya, Familoni, Ranti, Chibuzor, Nwuriku, Olunuga, Taiwo Olabisi, Ejim, Emmanuel, Rasheed Olaide, Awodu, Ojji, Dike, Sanni, Bushra, Ajuluchukwu, Jane N, Balogun, Michael O, Omotoso, Ayodele B, Ajit, Mullasari, Falase, Ayodele O
Format:	Journal Article
Language:	English
Published:	England John Wiley and Sons Inc 04-01-2022 Wiley
Subjects:	acute coronary syndrome Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - epidemiology Acute Coronary Syndrome - therapy Adult Aged Angina, Unstable - therapy Coronary Artery Disease - diagnosis Coronary Artery Disease - epidemiology Coronary Artery Disease - therapy Female Humans incidence intervention times Male Middle Aged Nigeria - epidemiology Non-ST Elevated Myocardial Infarction - diagnosis Original Research Percutaneous Coronary Intervention Registries reperfusion mortality ST Elevation Myocardial Infarction - diagnosis ST Elevation Myocardial Infarction - epidemiology ST Elevation Myocardial Infarction - therapy Treatment Outcome Nigeria acute coronary syndrome intervention times incidence reperfusion mortality
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Summary:	Background Coronary artery disease was hitherto a rarity in Africa. Acute coronary syndrome (ACS) accounts for coronary artery disease-related morbidity and mortality. Reports on ACS in Africa are few. Methods and Results We enrolled 1072 indigenous Nigerian people 59.2±12.4 years old (men, 66.8%) with ACS in an observational multicentered national registry (2013-2018). Outcome measures included incidence, intervention times, reperfusion rates, and 1-year mortality. The incidence of ACS was 59.1 people per 100 000 hospitalized adults per year, and comprised ST-segment-elevation myocardial infarction (48.7%), non-ST-segment-elevation myocardial infarction (24.5%), and unstable angina (26.8%). ACS frequency peaked 10 years earlier in men than women. Patients were predominantly from urban settings (87.3%). Median time from onset of symptoms to first medical contact (patients with ST-segment-elevation myocardial infarction) was 6 hours (interquartile range, 20.1 hours), and only 11.9% presented within a 12-hour time window. Traditional risk factors of coronary artery disease were observed. The coronary angiography rate was 42.4%. Reperfusion therapies included thrombolysis (17.1%), percutaneous coronary intervention (28.6%), and coronary artery bypass graft (11.2%). Guideline-based pharmacotherapy was adequate. Major adverse cardiac events were 30.8%, and in-hospital mortality was 8.1%. Mortality rates at 30 days, 3 months, 6 months, and 1 year were 8.7%, 9.9%, 10.9%, and 13.3%, respectively. Predictors of mortality included resuscitated cardiac arrest (odds ratio [OR], 50.0; 95% CI, 0.010-0.081), nonreperfusion (OR, 34.5; 95% CI, 0.004-0.221), pulmonary edema (OR, 11.1; 95% CI, 0.020-0.363), left ventricular diastolic dysfunction (OR, 4.1; 95% CI, 0.091-0.570), and left ventricular systolic dysfunction (OR, 2.1; 95% CI, 1.302-3.367). Conclusions ACS burden is rising in Nigeria, and patients are relatively young and from an urban setting. The system of care is evolving and is characterized by lack of capacity and low patient eligibility for reperfusion. We recommend preventive strategies and health care infrastructure-appropriate management guidelines.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Supplementary Material for this article is available at https://www.ahajournals.org/doi/suppl/10.1161/JAHA.120.020244 For Sources of Funding and Disclosures, see page 12.
ISSN:	2047-9980 2047-9980
DOI:	10.1161/JAHA.120.020244