Treatment Outcome of Acute Coronary Syndromes and its determinants at Two Tertiary Hospitals in Ethiopia: Prospective cohort Study

Abstract

The burden of cardiovascular diseases, particularly ischemic heart disease is figured out to escalate in Ethiopia. Despite increasing burden of ischemic heart disease in Ethiopian, acute coronary syndrome is a forgotten domain and a few data are available. Objective: To assess treatment outcome of Acute Coronary Syndrome in patients admitted to JUMC, and St. Peter Hospital, from March -August, 2018. Methods: Prospective cohort study was conducted at Jimma University medical center and St. Peter hospital in Ethiopia. Adult patients with confirmed ACS diagnosis were consecutively included from March-August, 2018. Data on patient demography, presentation, management and outcomes were collected and the patients were followed from admission to 30 days. Cox-regression model was used to determine predictors of 30 day survival. Statistical significance was considered at p value <0.05 Results: A total of 181 patients with confirmed ACS were enrolled (61% with ST-elevation myocardial infarction [STEMI], 39% with non–ST elevation–ACS). Mean (SD) age at presentation was 56 (±12) years and did not differ among ACS types. The mean symptom onset to hospital presentation time was 54hr, (±26). In-hospital and discharge anti-platelet and statins use were high (>90%), although none of the patients get any form of early revascularization. The use of beta-blockers and ACEIs were variable (80% vs 72%) in hospital and (71%vs 70%) at discharge respectively. The overall 30 day mortality rate was 20% with higher death in STEMI (26%) compared to non-STMI/UA (11.4%). Non fatal MACE was occurred in 22% patients. Rural residence (AHR=2.4 CI 1.23-4.66), STEMI [AHR 3.05, (1.14- 8.89)], prior stroke [AHR 15.14, (3.61-63.50)], GRACE-Score [AHR 1.026, (1.01-1.04)], and cardiogenic shock [AHR 4.46 2.02-9.81)] were factors associated with high risk of 30 day mortality after adjusted for confounders. Factor associated with a lower risk were hemoglobin at admission (HR 0.843, CI 0.75-0.96). Conclusion: The overall mortality of ACS in our study was alarmingly high, and reveals the need of instantaneous intervention by government and other stakeholders to improve outcome ACS patients.