Title : Percutaneous coronary intervention in Africa: A systematic review of associated outcomes
Abstract:
Background: Percutaneous Coronary Intervention (PCI) is a minimally invasive procedure that plays an important role in relieving an occlusion of the coronary arteries, allowing easy blood circulation to the cardiac tissues. It is mostly used in emergency acute coronary syndrome; however, it can be used in elective acute coronary syndrome. Currently, there is an increase in the use of PCI across the African continent, and this review aims to evaluate the clinical outcomes of PCI use in African patients with coronary heart disease.
Methods: A comprehensive search was conducted on PubMed, EMBASE via Ovid, and AJOL from inception to February 2025. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used in this study. We included studies reporting adults (>/=18) of any gender who had undergone percutaneous coronary intervention as a treatment for coronary heart disease (Stable angina, Unstable angina, NSTEMI, STEMI, or silent myocardial infarction) in any African country and reported at least one clinical outcome of interest. 302 articles underwent full screening following the predefined eligibility criteria, and 31 articles were included for qualitative analysis. The Primary outcomes assessed were all- cause mortality and Major Adverse Cardiovascular Events (MACE). Secondary outcomes included post-procedural outcomes like complications and post-procedure TIMI flow grade.
Results: This review synthesized 31 articles from nine African countries. A total of 11,507 patients participated in this study, and 10,701 patients underwent PCI procedures with stenting being the most common technique employed. Among participants 8,620 (74.3%) are male, and 2,887 (24.8%) are female. A total of 170(17.8%) MACE cases were reported, and an overall mortality of 457(4.9%) was reported, while in- hospital mortality accounted for 317 of the total mortality-making up 4.7% of the assessed patients. About 78.2% of patients who underwent PCI achieved post-procedure TIMI flow grade III-an indicator of post-procedure reperfusion success rate in the study. The most common complications reported include: Heart failure (19.1%), arrhythmia (9.1%), revascularization (8.9%), coronary events (8.1%), structural complications (8.1%), and the need for ICU support (7.9%). An allergic reaction (4.7%), a rare complication, was also reported.
Conclusion: The study shows that mortality rates are relatively higher when compared to higher-resource countries. STEMI remains the predominant indication for PCI, underscoring a healthcare system that is still largely reactive rather than preventive. The high burden of comorbidities such as smoking, hypertension, and diabetes, paired with complication rates including heart failure and major adverse cardiovascular events, reflects systemic gaps in both acute and chronic cardiovascular care. Marked geographic imbalances, incomplete data reporting, and limited long-term follow-up constrain the generalizability of findings and underscore the urgent need for investment in national and regional PCI registries, equitable expansion of interventional cardiology infrastructure, and integration of PCI data into broader non-communicable disease surveillance frameworks.
Keywords: Percutaneous Coronary Intervention, Coronary Artery Disease, Acute Coronary Syndrome, Outcomes, Africa.
