Outcomes of Acute Coronary Syndrome in Africa: a systematic review and meta-analysis

Acute coronary syndrome (ACS) represents an escalating public health crisis in Africa, driven by an ongoing epidemiological transition. Unlike in high-income countries, ACS in Africa disproportionately affects a younger, economically active demographic, imposing a severe socioeconomic burden. We aimed to synthesize contemporary evidence on the clinical characteristics and outcomes of ACS across the continent. A comprehensive search of PubMed, Embase, and Scopus was conducted from January 2010 to February 2024 to identify studies reporting on the prevalence, incidence, morbidity, and mortality of ACS in African populations. Primary outcomes included in-hospital mortality, ICU admission, and post-discharge outcomes. Risk of bias was assessed using the Newcastle–Ottawa Scale and Joanna Briggs Institute (JBI) Critical Appraisal Checklist for observational studies while the Cochrane Risk of Bias tool was used for randomized controlled trials. Data synthesis involved meta-analysis using random-effects models, supplemented by narrative synthesis, with subgroup analyses performed by ACS subtype. Fifty-three studies (53) comprising 27,346 individuals were included; however, geographic representation was heavily skewed toward Northern and Southern Africa. STEMI was the most prevalent ACS subtype (52.2%). The pooled ICU admission rate was 59.2%. In-hospital mortality was 9.1%, with STEMI carrying the highest subtype-specific mortality at 10.3%. Post-discharge data were limited by severe attrition; among reporting studies, mortality rose sharply from 6.0% at 30 days to 10.6% at 6 months and 14.5% at one year. The pooled rehospitalization rate of 5.4% likely underestimates true burden, given substantial loss to follow-up and financial barriers to care. Despite uneven geographic representation, available evidence highlights a severe and rising ACS burden across Africa. The disproportionate in-hospital STEMI mortality underscores significant infrastructural deficits in rapid reperfusion, while the steep rise in long-term mortality may reflect critical gaps in secondary prevention and treatment adherence. There is an urgent need to expand cost-effective pharmaco-invasive approaches, strengthen secondary prevention, and establish structured regional registries to accurately capture the continent-wide post-discharge burden. CRD42024616229.