Background. - Whereas the coronary artery disease death rate has declined in high-incomecountries, the incidence of acute coronary syndromes (ACS) is increasing in sub-Saharan Africa,where their management remains a challenge.Aim. - To propose a consensus statement to optimize management of ACS in sub-Saharan Africaon the basis of realistic considerations.Methods. - The AFRICARDIO-2 conference (Yamoussoukro, May 2015) reviewed the ongoing fea-tures of ACS in 10 sub-Saharan countries (Benin, Burkina-Faso, Congo-Brazzaville, Guinea, IvoryCoast, Mali, Mauritania, Niger, Senegal, Togo), and analysed whether improvements in strategiesand policies may be expected using readily available healthcare facilities.Results. - The outcome of patients with ACS is affected by clearly identified factors, including:delay to reaching first medical contact, achieving effective hospital transportation, increasedtime from symptom onset to reperfusion therapy, limited primary emergency facilities (espe-cially in rural areas) and emergency medical service (EMS) prehospital management, and hencelimited numbers of patients eligible for myocardial reperfusion (thrombolytic therapy and/orpercutaneous coronary intervention [PCI]). With only five catheterization laboratories in the10 participating countries, PCI rates are very low. However, in recent years, catheterizationlaboratories have been built in referral cardiology departments in large African towns (Abidjanand Dakar). Improvements in patient care and outcomes should target limited but selectedobjectives: increasing awareness and recognition of ACS symptoms; education of rural-basedhealthcare professionals; and developing and managing a network between first-line healthcarefacilities in rural areas or small cities, emergency rooms in larger towns, the EMS, hospital-basedcardiology departments and catheterization laboratories.Conclusion. - Faced with the increasing prevalence of ACS in sub-Saharan Africa, healthcarepolicies should be developed to overcome the multiple shortcomings blunting optimal manage-ment. European and/or North American management guidelines should be adapted to Africanspecificities. Our consensus statement aims to optimize patient management on the basis ofrealistic considerations, given the healthcare facilities, organizations and few cardiology teamsthat are available.
