Management Delays and Outcomes in ST-Elevation Myocardial Infarction (STEMI) in the COVID-19 Era in Senegal: Insights from a Tertiary Center

Abstract

Low-and middle-income countries (LMICs) face many challenges regarding the timely management of STEMI, and the COVID-19 pandemic has impacted our already fragile health systems. The aim of this study was to assess the delays in managing STEMI during COVID-19 and evaluate the 6-month mortality rates related to these delays. A retrospective cross-sectional study was conducted over two years starting from January 2020 at a tertiary center in Dakar, Senegal. All patients referred for STEMI during the study period were included. Statistical analysis was performed using R, version 4.4.0 (R Foundation for Statistical Computing). A total of 273 patients were enrolled during the study period (65.9% males, mean age: 59 ± 12.4). Diabetes Mellitus was present in 37.7% of cases. Only 1 out of 5 patients (20.5%) reached medical attention within 1 hour after symptoms onset, and the time from first medical contact to ECG was < 10 minutes in 39 % of cases. Primary PCI within the first 24 hours was performed in 23.5% of cases. Factors significantly associated with late hospital admission (<12h) were first medical contact < 1h (P 0.0009, OR: 4.06 95% CI; 1.8-9.64), time to first ECG < 10 minutes (P 0.002, OR: 2.79 95% CI; 1.45-5.41) and number of facilities visited < 2 (P 0.004, OR: 3.4 95% CI 1.51-8.22). The 6-month mortality rate was 18.7%, and the probability of death increased with a more significant delay in first medical contact. Our study found persisting delays in STEMI management in Senegal. Establishing a standard of care for STEMI in Senegal is mandatory to overcome healthcare system weaknesses and improve the outcomes of our STEMI patients.