Management of Acute Coronary Syndromes in the Era of Interventional Cardiology in Togo

Background: Togolese cardiology has seen significant progress since 2019 with the installation of two interventional Cathlab. This work therefore has the general objective of evaluating the impact of this progress on the management of acute coronary syndromes in Togo. Material and Method: This was a multicenter descriptive and analytical cross-sectional study with retrospective data collection over a period of 4 years, extending from January 2021 to December 2023. It collected epidemiological, clinical, paraclinical, and evolving data on coronary acute syndrome (ACS) in 6 hospital centers spread across the Togolese territory (Sylvanus Olympio Teaching Hospital, Campus Teaching Hospital, Kara Teaching Hospital, Nadouvi Lawson-Body Hospital, Private Hospital Autel d’Elie, and Dogta-Lafiè Hospital). The data were analysed with EpiInfo software version 7.2.5.0. The search for mortality factors and comparison of characteristics of patients who were revascularized by percutaneous coronary intervention or not were performed using both univariate and multivariate logistic regression methods. The statistical significance threshold was p Results: The prevalence of ACS was 5.87%. The mean age was 58 ± 12.75 years with a male predominance (sex ratio (M/F) 1.60). The main cardiovascular risk factor was hypertension (46.86%). Health insurance was present in 12.13%. Chest pain was present in 90.38% of patients, with a mean time between the onset of chest pain and hospital admission of 61.18 ± 103.77 hours. The presentation of ACS was dominated by ACS with ST segment elevation in 64.02% with a predominant anterior location in 54.39% of cases. Coronary angiography was performed in 50.63% of patients and allowed the left anterior descending artery to be noted in 47.93 as the culprit artery. Among the patients who performed a coronary angiography, only 35.54% had undergone percutaneous coronary intervention, including 23.52% primary percutaneous coronary intervention. The use of percutaneous coronary intervention was associated with many factors, including medical transportation methods, diabetes, heritability of coronary artery disease, typical chest pain, high heart rate, left anterior descending artery as culprit artery of ACS, and three-vessel coronary arterial disease. The evolution was marked by 11.72% deaths. Heart failure and cardiogenic shock were significantly associated with lethality. Percutaneous coronary intervention did not appear as a protective factor of death. Conclusion: Interventional cardiology procedures including coronary angiography and percutaneous coronary intervention are poorly practiced in acute coronary syndrome in Togo. Several obstacles block their adequate realization. These obstacles should be identified to promote this progress in the management of coronary heart disease in Togo.