Management and 30-Day Mortality of Acute Coronary Syndrome in a Resource-Limited Setting: Insight From Ethiopia. A Prospective Cohort Study

Abstract

Background: Despite the fact that the burden, risk factors, and clinical characteristics of acute coronary syndrome (ACS) have been studied widely in developed countries, limited data are available from sub-Saharan Africa. Therefore, this study aimed at evaluating the clinical characteristics, treatment, and 30-day mortality of patients with ACS admitted to tertiary hospitals in Ethiopia.Methods: A total of 181 ACS patients admitted to tertiary care hospitals in Ethiopia were enrolled from March 15 to November 15, 2018. The clinical characteristics, management, and 30-day mortality were evaluated by ACS subtype. The Cox proportional hazards model was used to determine the predictors of 30-day all-cause mortality. A p-value < 0.05 was considered statistically significant.Results: The majority (61%) of ACS patients were admitted with ST-segment elevation myocardial infarction (STEMI). The mean age was 56 years, with male predominance (62.4%). More than two-thirds (67.4%) of patients presented to hospital after 12 h of symptom onset. Dyslipidemia (48%) and hypertension (44%) were the most common risk factors identified. In-hospital dual antiplatelet and statin use was high (>90%), followed by beta-blockers (81%) and angiotensin-converting enzyme inhibitors (ACEIs; 72%). Late reperfusion with percutaneous coronary intervention (PCI) was done for only 13 (7.2%), and none of the patients received early reperfusion therapy. The 30-day all-cause mortality rate was 25.4%. On multivariate Cox proportional hazards model analysis, older age [hazard ratio (HR) = 1.03, 95% CI = 1.003–1.057], systolic blood pressure (HR = 0.99, 95% CI = 0.975–1.000), serum creatinine (HR = 1.32, 95% CI = 1.056–1.643), Killip class > II (HR = 4.62, 95% CI = 2.502–8.523), ejection fraction <40% (HR = 2.75, 95% CI = 1.463–5.162), and STEMI (HR = 2.72, 95% CI = 1.006–4.261) were independent predictors of 30-day mortality.Conclusions: The 30-day all-cause mortality rate was unacceptably high, which implies an urgent need to establish a nationwide program to reduce pre-hospital delay, promoting the use of guideline-directed medications, and increasing access to reperfusion therapy.

Clinical profile and 30-day outcome of patients with acute coronary syndrome

“…20 Heart failure and cardiogenic shock were seen in 9.09% and 6.36% of patients, respectively, findings consistent with those of Sidhu et al, 20 the ACCESS study, 22 and the CREATE registry. 23 The overall 30-day mortality rate in the present study was 5.82%, which was significantly lower as compared to a study by Fanta et al 31 The present study showed higher composite MACE in the STEMI subgroup in the 30-day outcome, similar to findings in the CREATE registry, which attributed poverty, affordability of treatment, and delayed access to hospitals to ACS-associated morbidity and mortality. 23 In the present study, the mortality rate was significantly higher among ACS patients with severe LV dysfunction (LVEF <30%), as observed in both in-hospital and 30day outcomes.…”

Adapting an Intervention to Improve Acute Myocardial Infarction Care in Tanzania: Co-Design of the MIMIC Intervention

“…As the burden of AMI in sub-Saharan Africa continues to rise [40], there will be a growing need for research programs to monitor AMI care and implement interventions to maximize uptake of evidence-based care. To date, only a handful of published studies describe AMI care patterns in the region, and these studies have mostly been conducted at specialized cardiac centers with access to cardiologists and advanced coronary interventions [41][42][43]. Unfortunately, access to such advanced cardiac care is currently extremely limited in sub-Saharan Africa [44,45], and so the vast majority of AMI care is likely to occur in hospital settings like ours in the near future.…”

Daily exercise improves the long-term prognosis of patients with acute coronary syndrome

“…Previous medical history, such as previous MI, and previous PCI was related to the ischemia risk of ACS patients, which predicted the occurrence of adverse events in such patients. In addition, several studies have demonstrated that systolic pressure, serum creatinine, and HDL played an important role in predicting the incidence of cardiovascular events ( 42 , 43 ). NT-proBNP was a sensitive indicator for evaluating the cardiac function of patients, which predicted the mortality of patients with ACS ( 44 , 45 ).…”

“…Similarly, the LVEDD was also an important indicator reflecting the functional load of the cardiac pump, which also affected the prognosis of ACS patients ( 46 ). The Killip class and SYNTAX score reflected the cardiac function and complexity of coronary lesions, respectively, which were the determinants of the severity of ACS and also played an important role in predicting adverse outcomes ( 43 , 47 ). As for ACS patients with the muti-vessel disease, Iqbal et al ( 48 ) has demonstrated that the untreated proximal LAD (HR, 1.23; 95%CI, 1.06–1.51; P = 0.045) and RCA (HR, 1.36; 95%CI, 1.08–1.65; P = 0.007) were both associated with the increased mortality.…”