Short-Term Outcomes after Coronary Artery Bypass Grafting in Africa: A Narrative Systematic Review with New Evidence from Cameroon
Résultats à Court Terme Après un Pontage Aortocoronarien en Afrique : Une Revue Narrative Systématique Enrichie de Nouvelles Données Issues du Cameroun
DOI:
https://doi.org/10.5281/zenodo.20169503Keywords:
coronary artery disease, coronary artery bypass grafting, cardiac surgery, Africa, early mortalityAbstract
ASTRACT
Introduction. Although coronary artery disease (CAD) is increasingly prevalent in Africa, data on myocardial revascularization, whether by percutaneous procedures or coronary artery bypass grafting (CABG), remain scarce. This report reviews the outcomes following CABG in Africa and contextualizes new data from a Cameroonian institution within the existing literature. Methods. A narrative systematic review was conducted in accordance with PRISMA 2020 guidance. PubMed/MEDLINE, Scopus, African Journals Online (AJOL), and Google Scholar were searched for African studies reporting patient demographics, perioperative data, in-hospital, or 30-day outcomes after CABG. Unpublished data from 25 consecutive isolated CABG patients operated on in Cameroon between 2011 and 2025 were also included. Results. African patients undergoing CABG are typically men in their 60s with a high prevalence of angina, multivessel disease, and risk factors like hyperlipidemia and smoking. While pooled early mortality across Africa is 3.5%, it varies by region, reaching 11.2% in some series. In Cameroon, operative mortality is 4.5%, with key predictors of death being advanced heart failure (NYHA >class III), prolonged CPB time (≥180 min), and significant blood loss (≥2000 mL). Conclusion. In African patients, CABG is primarily performed on men with high cardiovascular risk, where early mortality is driven by advanced heart failure, necessitating optimized patient selection and regional clinical registries.
RÉSUMÉ
Introduction. Bien que la maladie coronarienne soit de plus en plus prévalente en Afrique, les données sur la revascularisation myocardique, qu'elle soit réalisée par procédures percutanées ou par pontage aortocoronarien (PAC), restent rares. Ce rapport examine les résultats après un PAC en Afrique et contextualise de nouvelles données issues d'une institution camerounaise au sein de la littérature existante. Méthodes. Une revue systématique narrative a été menée conformément aux directives PRISMA 2020. Les bases de données PubMed/MEDLINE, Scopus, African Journals Online (AJOL) et Google Scholar ont été consultées pour identifier les études africaines rapportant la démographie des patients, les données périopératoires, ainsi que les résultats hospitaliers ou à 30 jours après une PAC. Des données non publiées concernant 25 patients consécutifs ayant subi une PAC isolée au Cameroun entre 2011 et 2025 ont également été incluses. Résultats. Les patients africains subissant un pontage aorto-coronarien (PAC) sont généralement des hommes dans la soixantaine, présentant une forte prévalence d'angine de poitrine, d'atteintes multitronculaires et de facteurs de risque tels que l'hyperlipidémie et le tabagisme. Alors que la mortalité précoce globale en Afrique est de 3,5 %, elle varie selon les régions, atteignant 11,2 % dans certaines séries. Au Cameroun, la mortalité opératoire est de 4,5 %, les principaux facteurs prédictifs de décès étant l'insuffisance cardiaque avancée (stade NYHA > III), un temps de circulation extracorporelle prolongé (≥ 180 min) et une perte de sang peropératoire importante (≥ 2000 mL). Conclusion. Chez les patients africains, le PAC est principalement pratiqué sur des hommes présentant un risque cardiovasculaire élevé, où la mortalité précoce est dictée par l'insuffisance cardiaque avancée, nécessitant une sélection optimisée des patients et la mise en place de registres cliniques régionaux.
References
1. Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: Part I—General considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104(22):2746–2753.
2. Onen CL. Epidemiology of ischemic heart disease in sub-Saharan Africa. Cardiovascular Journal of Africa. 2013;24(2):34–42.
3. Gupta R, Yusuf S. Challenges in management and prevention of ischemic heart disease in low socioeconomic status populations. BMC Medicine. 2019;17(1):209.
4. Mensah GA, Roth GA, Fuster V. The global burden of cardiovascular diseases and risk factors. Journal of American College of Cardiology. 2019;74(20):2529–2532.
5. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019. Journal of American College of Cardiology. 2020;76(25):2982–3021.
6. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal. 2019;40(2):87–165.
7. Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M, et al. Strategies for multivessel revascularization in patients with diabetes. New England Journal of Medicine. 2012;367(25):2375–2384.
8. Wu C, Camacho FT, Wechsler AS, Lahey S, Culliford AT, Jordan D, et al. Risk score for predicting long-term mortality after coronary artery bypass graft surgery. Circulation. 2012;125(20):2423–2430.
9. Edwin F. The development of cardiac surgery in West Africa. Cardiovascular Journal of Africa. 2011;22(5):240–244.
10. Zilla P, Yacoub M, Zühlke L, et al. Global unmet needs in cardiac surgery. The Lancet. 2018;391(10128):2079–2080.
11. Yankah CA, Fynn-Thompson F. Cardiac surgery in Africa: Quo vadis? Seminar in Thoracic and Cardiovascular Surgery 2019;31(3):438–444.
12. Boukhmis A, Nouar ME, Guerchani MK. Applicability of the commonly used risk scores for coronary bypass surgery in Algeria. Journal of Saudi Heart Association. 2022;34(1):24–31.
13. Mocumbi AO. Heart failure in sub-Saharan Africa. Heart. 2012;98(4):342–348.
14. Akintoye OO, Fasina OP, Adiat TS, Nwosu PU, Olubodun MO, Adu BG. Outcomes of coronary artery bypass graft surgery in Africa: A systematic review and meta-analysis. Cureus. 2023;15(10):e47541.
15. Reiche S, Mpanya D, Vanderdonck K, Mogaladi S, Motshabi-Chakane P, Tsabedze N. Perioperative outcomes of coronary artery bypass graft surgery in Johannesburg, South Africa. Journal of Cardiothoracic Surgery. 2021;16:7.
16. Birkmeyer JD, Siewers AE, Finlayson EVA, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. New England Journal of Medicine. 2002;346(15):1128–1137.
17. Laffey JG, Boylan JF, Cheng DCH. The systemic inflammatory response to cardiopulmonary bypass: Pathophysiology and therapeutic approaches. Anesthesiology. 2002;97(1):215–252.
18. Santos CA, Oliveira MA, Brandi AC, Botelho PHH, Brandi JCM, Santos MA, et al. Risk factors for mortality in patients undergoing coronary artery bypass graft surgery. Revista Brasileira de Cirurgia Cardiovascular. 2014;29(4):513–520.
19. Mocumbi AO, Sliwa K. Women’s cardiovascular health in Africa. Heart. 2012;98(15):1136–1142.
20. Nashef SAM, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, et al. EuroSCORE II. European Journal of Cardiothoracic Surgery. 2012;41(4):734–744.
21. Shahian DM, Jacobs JP, Badhwar V, Kurlansky PA, Furnary AP, Cleveland JC Jr, et al. The Society of Thoracic Surgeons 2018 adult cardiac surgery risk models: Part 1—Background, design considerations, and model development. Annals of Thoracic Surgery. 2018;105(5):1411–1418.
22. O’Brien SM, Feng L, He X, Xian Y, Jacobs JP, Badhwar V, et al. The Society of Thoracic Surgeons 2018 adult cardiac surgery risk models: Part 2—Statistical methods and results. Annals of Thoracic Surgery. 2018;105(5):1419–1428.
23. Murphy GJ, Reeves BC, Rogers CA, Rizvi SI, Culliford L, Angelini GD. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation. 2007;116(22):2544–2552.
24. Hajjar LA, Vincent JL, Galas FRBG, Nakamura RE, Silva CMP, Santos MH, et al. Transfusion requirements after cardiac surgery: The TRACS randomized controlled trial. Journal of the American Medical Association. 2010;304(14):1559–1567.
25. Waly HM, Elayda MA, Lee VV, El-Said G, Reul GJ, Hall RJ. Risk factor analysis among Egyptian patients who underwent coronary artery bypass surgery. Texas Heart Institute Journal. 1997;24(3):204–208.
26. Sanusi M, Falase B, Ismail S, et al. Off-pump coronary artery bypass surgery in a Nigerian teaching hospital. Panafrican African Medical Journal. 2013;14:122.
27. Chelli M, Ben Ahmed H, Selmi K, et al. Single versus bilateral internal thoracic artery grafts for multivessel coronary artery bypass grafting: Effects on mortality and event-free survival. La Tunisie Médicale. 2012;90(10).
28. Moutakiallah Y, et al. Coronary artery bypass surgery in type 2 diabetic patients: Predictors of mortality and morbidity. Cardiothoracic Surgery 2019;27:6.
29. El Mourabit Y, Tribak M, Leghlimi H, El Amraoui W, Laaroussi M, El Bakkali A, Mermade L, Moughil S. Le pontage coronarien chez le sujet de moins de 45 ans: Profil caractéristique et résultat à long terme. Annales de Cardiologie et d’Angéiologie (Paris). 2025;74(3):101900. doi:10.1016/j.ancard.2025.101900.
30. Diagne PA, et al. Results of the first 10 cases of coronary bypass surgery in Senegal. World Journal of Cardiovascular Surgery. 2024;14:45–60.
31. Elassy S, El-Bawab H, Abd El Fatah M. Early outcome of coronary artery bypass surgery in patients with poor left ventricular function. Egyptian Heart Journal. 2014;66(Suppl 1):9.
32. Khalifa YSE, Eisa KM, Abdel Bary M, Ismail HEMM, Taha AM. Short-term outcome of coronary artery bypass graft surgery: Evaluation of a recently established cardiac center. Journal of Egyptian Society of Cardiothoracic Surgery. 2018;26(1):24–29.
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Copyright (c) 2026 Charles Mve Mvondo, Ela Bella Amos, Sonia Bodiong Banana, Jean Claude Ambassa, Tantchou Tchoumi Cabral, Laurence Carole Ngo Yon, Anshoma Ellen, Zephanie Kobe Folkabo, Stephane Arroye Betou, William Ngatchou Djomo, Louis Richard Njock
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