Profile and management of acute coronary syndromes at primary- and secondary-level healthcare facilities in Cape Town

Cardiovasc J Afr. 2022;33(3):138-144. doi: 10.5830/CVJA-2021-054. Epub 2021 Nov 16.

Abstract

Background: Little is known about the clinical profile and management of patients with acute coronary syndromes (ACS) in the South African public sector.

Methods: We conducted a retrospective study of patients presenting with ACS to a secondary-level healthcare facility in Cape Town during a one-year period to study the clinical profile and management of these patients.

Results: Among the 214 patients in this cohort, 48 (27.5%) had ST-segment elevation myocardial infarction (STEMI), 43 (24.7%) had non-ST-segment elevation myocardial infarction and 83 (47.7%) unstable angina pectoris. We identified high rates of >12-hour delays in first medical contact after symptom onset (46%) and inaccurate ECG diagnosis of STEMI (29.2%), which were associated with low rates of thrombolysis (39.6%). High rates of non-adherence and ACS recurrence were also observed.

Conclusion: To address the local challenges in ACS management highlighted in this study, we propose the development of a regional referral network prioritising access to expedited care and primary reperfusion interventions in ACS.

Keywords: acute coronary syndrome; ST‐segment elevation myocardial infarction; non‐ST‐segment elevation myocardial infarction; unstable angina pectoris.

MeSH terms

  • Acute Coronary Syndrome* / diagnosis
  • Acute Coronary Syndrome* / epidemiology
  • Acute Coronary Syndrome* / therapy
  • Delivery of Health Care
  • Humans
  • Myocardial Infarction* / diagnosis
  • Non-ST Elevated Myocardial Infarction*
  • Retrospective Studies
  • ST Elevation Myocardial Infarction* / diagnosis
  • ST Elevation Myocardial Infarction* / epidemiology
  • ST Elevation Myocardial Infarction* / therapy
  • South Africa / epidemiology