Background: Coronary heart disease remains the leading cause of morbidity and mortality in both men and women worldwide. Cardiovascular
disease (CVD) is on the rise in sub-saharan countries that are currently undergoing rapid urbanization, industrialization, and lifestyle changes.
Recently, knowledge regarding sex differences in CVD has evolved.
Although, data on the incidence of acute coronary syndrome (ACS) in sub-saharan are not rare, few focused closely on sex differences. The purpose
of this study was to examine sex-related differences in characteristics, management and inhospital outcome in sub-saharan with acute coronary
syndrome.
Methods: This was a retrospective study conducted at the cardiology department of Principal Hospital of Dakar over a period of 60 months
(January 1st 2010 to December 31st 2014), in Dakar, Senegal. Two hundred and seven medical records of patients admitted for ACS based on
anginal pain at rest, suggestive electrocardiographic changes and elevated troponin I levels, were included. We studied data on age, risk factors,
symptoms, the time delay before admission, the management given, the vital parameters as as well as evolution during hospitalization. Medical
records were then stratified into two categories (males and females) to study diferences. The studied parameters were entered into an electronic
questionnaire using Epi Info version 3.3.5 of the World Health Organization.
Results: Hospital prevalence of ACS was 6.09% with a sex ration M/F of 1.62(159/98). there was an overall rates increase of admissions for
ACS in both men and women . The mean age of patients was 67.5 ± 10.1 years with a range of 44 and 93 years. Females were older than males
( p=0.08) with a greatest incidence of ACS in those aged 60 to 69 years. Women had a higher prevalence of risks, such as diabetes, hypertension,
dyslipidemia, and obesity than men. In addition, there are sex differences in an order of importance related to risk factors for ACS. Hypertension,
diabetes, and obesity are the most important risk factors in women, whereas current smoking, hypertension and diabetes are the important risk
factors in men. Chest pain was present in 249 patients (97%). Typical anginal pain was more common in men than women (76.1% vs 52.1%), this
difference was statistically significant (p=0.000). The average time delay before medical care was given was 29.09 ± 8.5 hours. This time delay
was higher in women than men ( 53.9 ± 18 hours vs 26.4 ± 12.3 hours; p= 0.005) Mean troponin I level found was 1.9 ± 2.8 ng/ml, Creatine
phosphokinase and Creatine phosphokinase-MB measured 824 ± 909.7 UI/l and 141.3 ± 245.9 UI/l respectively. Troponin I level was higher in
men than women. Mean total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol and, triglyceride were
2.06 ± 0.25 g/l, 0.90 ± 0.2g/l, 0.90 ± 0.20 g/l, and 1.44 ± 0.20 g/l respectively. LDL cholesterol was higher in women than in men. Electrocardiogram
revealed an ACS with persistent ST-elevation in 143 patients (90 males vs 53 females) and non ST-elevation ACS in 114 patients (69 males vs 45
females). Concerning treatment, thrombolysis using streptokinase was performed in 33 patients, accounting for 12.8% of patients with ST-elevation.
Thrombolysis was performed in 10.2% of females compared to 14.5% of males (p=0.32). Six deaths (6.1%) were recorded in women and 10 (6.3%
) in men. Complications was dominated by pulmonary oedema.
Conclusion: Our study confirms that acute coronary syndrome is not a “man’s only” disease in sub-sahara.
Although in our study there was no difference in mortality, atypical presentation and low elevations in biomarker were responsible of long time
delay before medical care in women.
Patient Characteristics, Risk Factors, and Disease Outcomes in Young Adults With St-Elevation Myocardial Infarction: Insights From The Kermanshah Acute Coronary Syndrome Registry
