Tele-ECG improves diagnosis of acute coronary syndrome and ST-elevation myocardial infarction in Côte d’Ivoire

Abstract

Introduction The emergence of cardiovascular risk factors in sub-Saharan Africa suggests an increasing incidence of acute coronary syndromes and STEMI. The aim of the study was to define the prevalence of STEMI and to describe the characteristics of patients diagnosed with STEMI within the tele-electrocardiogram (ECG) network in Côte d’Ivoire. Method A retrospective study was conducted from January 2015 to August 2019. All adult patients managed by one of the six hospitals within the telemedicine network who benefited from a remote interpretation of their ECG by the cardiology department of Bouaké University Hospital were included. The main reason for ECG interpretation, patient and ECG characteristics, diagnosis, response time and treatment were described. Results A total of 5649 patients were included. The prevalence of STEMI was 0.7% ( n = 44 cases) with a mean age of 58.6 ± 11.8 years and a M/F sex ratio of 1.93. Among STEMI patients, chest pain was the main reason for ECG testing (56.8%). Most ECGs were interpreted within 12 hours (72.8%). The anterior inter-ventricular artery location (59.1%, n = 26) was predominant. The Q wave of necrosis was absent in 18% ( n = 8) of cases. All patients received double anti-platelet aggregation and 50% ( n = 22) additional heparin therapy. No patient underwent primary angioplasty or thrombolysis, 65.9% ( n = 29) were referred to the Bouaké Cardiology Department and 34.1% ( n = 15) to the Abidjan Heart Institute. Scheduled angioplasty was performed in 20% ( n = 3) of patients in Abidjan. Conclusion Tele-ECG was an effective means of STEMI screening in Côte d’Ivoire. Systematic telethrombolysis of all patients diagnosed could improve their prognosis.