Quality of management of acute coronary syndrome at the Nouakchott National Heart Center (Mauritania)

Abstract

Introduction: Acute Coronary Syndrome (ACS) is a diagnostic and therapeutic emergency whose management is standardized by multiple learned societies.
Aim: To describe the quality of the management of the SCA at the National Heart Center (CNC) in Nouakchott, Mauritania.
Methods: This is a cross-sectional study of patients admitted to SCA at the Nouakchott CNC between July 31 and December 16, 2017.

Results: A total of 80 patients, were enrolled in this study (hospital prevalence: 10.6%). Males were predominant (sex ratio: 2.3) and mean age was 62.5±10.6. Only one fourth of patients had health insurance coverage. Medical transportation by ambulance were provided only for 29% of patients. Typical chest pain was the most frequent reason for consultation (83.8% of cases) and the average admission time was 34.83±11.87 hours. Almost two thirds of patients (68%) had an ST segment-elevation myocardial infarction. Of those patients, only 23 were managed within-12 hours of chest pain onset; reperfusion treatment was attempted by primary Percutaneous Coronary Intervention (PCI) in only one case and thrombolysis in 22 (28%) others and was success in 81% of cases. All ACS-patients received antithrombotic drugs as recommended by the local protocol and 55 (69%) patients underwent a coronary angiography that revealed 58.2% mono-truncular, 18.2% bi-truncular and 14.5% tri-truncular lesions, supporting the indication for PCI in 31 patients, Coronary artery bypass graft in 6 patients and medical therapy in the remaining patients. During the hospital course, complications were observed in 22.5% patients with a total mortality of 3.8%.
Conclusion: Management of ACS at the Mauritanian CNC could be optimized by the implementation of a pre-hospital care chain based on easy access to first-line facilities, efficient transportation system and early coronary revascularization.