Epidemiology, Management and Prognosis of Acute Coronary Syndromes in Senegal: A Systematic Review of the Grey Literature with Meta-analysis from 1998 to 2020

<i>Introduction</i>: The management of acute coronary syndromes (ACS) in Senegal continues to pose challenges, despite significant progress in medical care. To comprehensively understand the current state of ACS in Senegal, a systematic review with meta-analysis was deemed essential. The main objective of this study was to determine the prevalence of ACS in Senegal and its trajectory over time. <i>Methods</i>: A systematic review of grey literature, encompassing theses and dissertations on ACS conducted in public hospitals in Senegal between 1990 and 2023, was undertaken. The selected studies provided valuable insights into the prevalence, epidemiological characteristics, cardiovascular risk factors, diagnostic approaches, therapeutic interventions, and prognostic outcomes associated with ACS. A meta-analysis of prevalence and mortality data was performed using the DerSimonian-Laird random-effects model, while the remaining data were synthesized descriptively. <i>Results</i>: The systematic review yielded 15 eligible studies from 1998 to 2020, out of an initial 101 identified documents. The overall prevalence of ACS was determined to be 9% (95% Cl: 7-11%, 1<sup>2</sup> = 96%, p < 0.01). Notably, in Dakar, the prevalence exhibited a significant increase between 1998 to 2010 and 2013 to 2020 (p < 0.01), rising from 6% (95% Cl: 4-8%, 1<sup>2</sup> = 96%, p < 0.01) to 13% (95% CI: 9-16%, 1<sup>2</sup> = 95%, p < 0.01). The proportion of patients presenting with ST-elevation ACS ranged from 44 to 94%. The average age of patients varied between 57 and 64 years, with a consistent male predominance across all studies. A notable improvement in mean admission delay to cardiology services in Dakar was observed, decreasing from 186 hours in 2002 to 28 hours in 2018. Thrombolysis utilization for ST-elevation ACS patients in Dakar ranged from 2.1 to 64.8%, while other regions reported rates of 10% in Kaolack, 53.8% in Saint-Louis, and 52.6% in Thies. In Dakar, the rate of coronary angiography increased substantially from 0% to 60.6% between 1998 and 2020, with percutaneous coronary intervention performed in 4.3% to 35.3% of cases. The frequency of heart failure ranged from 6.7 to 52.9%, and cardiogenic shock occurred in 1 to 18.5% of patients. The overall mortality rate was 10% (95% CI: 7-13%, 1<sup>2</sup> = 64%, p < 0.01). <i>Conclusion</i>: Our study demonstrates that despite an increase in prevalence, there is an improvement in the management of ACS. However, the establishment of a national registry and a comprehensive network for ACS management is crucial to further improve morbidity and mortality outcomes.