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26-A-16365-ACC DOOR-TO-NEEDLE PERFORMANCE IN AFRICAN STEMI MANAGEMENT: A SYSTEMATIC META-ANALYSIS
Abstract   Peer reviewed

26-A-16365-ACC DOOR-TO-NEEDLE PERFORMANCE IN AFRICAN STEMI MANAGEMENT: A SYSTEMATIC META-ANALYSIS

Efeturi Maxwell Okorigba, Huzaifah Qureshi, Saim Rana, Mohamad Al-Saed, Ademola Ajibade, Pooja Warrier, Basel Abdelazeem, Carlson Sama, Muchi Ditah Chobufo and Sudarshan Balla
Journal of the American College of Cardiology, Vol.87(13 Supplement), p.A457
04/2026
DOI: 10.1016/j.jacc.2026.02.1251

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Abstract

Background Fibrinolysis remains the main reperfusion option for STEMI in settings without reliable PCI. Guidelines recommend door-to-needle time (DTNT) ≤30 minutes. We conducted the first continent-wide meta-analysis to assess real-world DTNTs in African hospitals. Methods We systematically searched PubMed/MEDLINE, Scopus, and Web of Science through July 2, 2025, for studies reporting DTNT for adult STEMI patients treated with thrombolysis in Africa. Pooled mean DTNT was estimated via random-effects meta-analysis with restricted maximum likelihood and Knapp-Hartung adjustment. Heterogeneity was assessed by Cochran’s Q and I2, and sensitivity analyses evaluated robustness. Results Across 12 eligible studies encompassing a total of 2,193 STEMI patients, about 1,261 (57.5%) received thrombolytic therapy. Among the 11 studies reporting mean reperfusion times (1,011 patients), the overall pooled mean DTNT was 74.8 minutes (95% CI, 44.4-105.2; I2 = 99.4%), substantially exceeding the recommended benchmark. Notably, only 36.3% of thrombolysed patients achieved a DTNT of ≤ 30 minutes. Furthermore, none of the included study cohorts reported an overall mean DTNT within 30 minutes. Conclusion STEMI patients in Africa experience major delays to fibrinolysis, with fewer than four in ten receiving timely therapy. Standardized reperfusion protocols, and quality improvement initiatives are urgently needed to reduce delays, enhance myocardial salvage, and improve outcomes.

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