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Background Coronary artery disease was hitherto a rarity in Africa. Acute coronary syndrome (ACS) accounts for coronary artery disease–related morbidity and mortality. Reports on ACS in Africa are few. Methods and Results We enrolled 1072 indigenous Nigerian people 59.2±12.4 years old (men, 66.8%) with ACS in an observational multicentered national registry (2013–2018). Outcome measures included incidence, intervention times, reperfusion rates, and 1‐year mortality. The incidence of ACS was 59.1 people per 100 000 hospitalized adults per year, and comprised ST‐segment–elevation myocardial infarction (48.7%), non–ST‐segment–elevation myocardial infarction (24.5%), and unstable angina (26.8%). ACS frequency peaked 10 years earlier in men than women. Patients were predominantly from urban settings (87.3%). Median time from onset of symptoms to first medical contact (patients with ST‐segment–elevation myocardial infarction) was 6 hours (interquartile range, 20.1 hours), and only 11.9% presented within a 12‐hour time window. Traditional risk factors of coronary artery disease were observed. The coronary angiography rate was 42.4%. Reperfusion therapies included thrombolysis (17.1%), percutaneous coronary intervention (28.6%), and coronary artery bypass graft (11.2%). Guideline‐based pharmacotherapy was adequate. Major adverse cardiac events were 30.8%, and in‐hospital mortality was 8.1%. Mortality rates at 30 days, 3 months, 6 months, and 1 year were 8.7%, 9.9%, 10.9%, and 13.3%, respectively. Predictors of mortality included resuscitated cardiac arrest (odds ratio [OR], 50.0; 95% CI, 0.010–0.081), nonreperfusion (OR, 34.5; 95% CI, 0.004–0.221), pulmonary edema (OR, 11.1; 95% CI, 0.020–0.363), left ventricular diastolic dysfunction (OR, 4.1; 95% CI, 0.091–0.570), and left ventricular systolic dysfunction (OR, 2.1; 95% CI, 1.302–3.367). Conclusions ACS burden is rising in Nigeria, and patients are relatively young and from an urban setting. The system of care is evolving and is characterized by lack of capacity and low patient eligibility for reperfusion. We recommend preventive strategies and health care infrastructure‐appropriate management guidelines.

BACKGROUND: Arterio-venous (AV) fistula is created for patients requiring renal replacement therapy (hemodialysis and hemofiltration). A failing A-V fistula requires urgent treatment to keep it patent. Understanding the simple tips and tricks will contribute to the quality of life for the patient with end-stage renal disease and reducing radiation dose to the operator. CASE SUMMARY: A 77 year old male with end-stage renal disease, hypertension and coronary artery disease. He has been on regular haemodialysis after A-V fistula (left forearm) was constructed in 2013. He presented with 2 weeks history of A-V fistula occlusion. Examination was essentially normal. Serum sodium=136mmol/l, potassium=5.5mmol/l urea=100mg/l, creatinine=3.5mg/dl. The Doppler scan showed 50 % stenosis just proximal to the anastomosis with calcification. Percutenous arteriography and venography was done with non-compliance balloon (3x12mm) up to 24 atm . The post procedure venography showed restoration of flow across the fistula. CONCLUSION: Endovascular treatment of a failing A-V fistula can be life saving. The simple tips and tricks of using the groin route, reducing the concentration of contrast and maneuver devices may contribute to safety and reduce radiation to the operator.