Determinants of in-Hospital Mortality Among Patients with Acute Coronary Syndrome at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: unmatched Case Control Study

Abstract

Background

Acute coronary syndrome causes significant mortality and morbidity. Patients with acute coronary syndrome continue to have a significant in-hospital mortality rate. The evidence on factors contributing to in-hospital mortality in resource-limited setups remains scarce. The goal of this study was to assess determinants of in-hospital mortality among patients with ACS at University of Gondar Comprehensive Specialized Hospital; Northwest Ethiopia.

Methods

An institution-based unmatched case-control study was conducted on admitted acute coronary syndrome patients from September, 2018 to May, 2022. We performed bi-variable logistic regression analysis followed by multivariable logistic regression analysis. P value < 0.05 and 95% CI were used to determine the association between independent variables and in-hospital mortality.

Results

The study was conducted on 159 acute coronary syndrome patients, 53 cases and 106 controls. The mean ± SD age of the participants was 59.67 years ± 13.4 and 62.72 years ±15.58 for controls and cases respectively. The determinants of in-hospital mortality were patients not initiated on B-blockers (AOR= 11.39, 95% CI: 2.32–55.96), cardiogenic shock (AOR= 7.23, 95% CI: 1.56–33.49), stroke (AOR = 7.61, 95% CI: 1.81–31.92), oxygen saturation < 90% (AOR = 5.31, 95% CI: 1.25–22.57) and hemoglobin level less than 12 g/dl (AOR=3.43, 95% CI: 1.13–10.35).

Conclusion

Patients not initiated on beta-blockers, development of cardiogenic shock and stroke, low oxygen saturation, and hemoglobin level below 12 g/dl were the determinants of in-hospital mortality. Therefore, early detection and treatment of complications and comorbidities should be routine practice to decrease the in-hospital mortality of patients with acute coronary syndrome.

Keywords:

• determinants
• acute coronary syndrome
• in-hospital mortality
• Ethiopia
• resource limited setting

Abbreviations

ACEIs, Angiotensin Converting Enzyme Inhibitors; ACSl, Acute coronary syndrome; AHA, American Heart Association; AMI, Acute Myocardial Infarction; AOR, Adjusted Odds Ratio; ARBs, Angiotensin Receptor Blockers; BBs, B-Blockers; BPM, Beats per minute; CABG, Coronary Artery Bypass Graft; CAD, Coronary Artery Disease; CCB, Calcium channel blocker; CHD, Coronary Heart Disease; CI, Confidence Interval; CVD, Cardiovascular diseases; DM, Diabetes Mellitus; ED, Emergency Department; ECG, Electrocardiogram; EF, Ejection fraction; EMS, Emergency Medical Services; GCS, Glasgow Coma Scale; GRACE, Global Registry of Acute Coronary Events; HDL, High density lipoprotein; HAART, Highly active antiretroviral therapy; HIV/AIDS, Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome; ICU, Intensive Care Unit; IHD, Ischemic heart disease; K, Potassium; LBBB, Left bundle branch block; LDL, Low density lipoprotein; LMICs, low- and middle-income countries; LVEF, Left ventricular ejection fraction; MI, Myocardial Infarction; NA, Sodium; NSTEMI, Non-ST Elevation Myocardial Infarction; PCI, Percutaneous Coronary Intervention; PHT, Pre-hospital time; PHC, Primary Healthcare; RBS, Random Blood Sugar; SGOT, Serum glutamic oxaloacetic transferase; SGPT, Serum glutamic pyruvic transferase; STEMI, ST Elevation Myocardial Infarction; SSA, Sub Saharan Africa; TASH, Tikur Anbessa specialized hospital; TC, Total cholesterol; TG, Triglyceride; UA, Unstable angina; UOG, University of Gondar; UOGCSH, University of Gondar Comprehensive specialized Hospital; UK, United Kingdom; WMA, Wall Motion Abnormality; WHO, World Health Organization.

Data Sharing Statement

The data-set is available from corresponding authors and can be obtained upon reasonable request.

Acknowledgments

All authors are grateful for the study’s medical record room staff, data collectors and supervisors. And we want to thank the Department of Internal medicine, the School of medicine and college of medicine and health sciences, and the University of Gondar for giving us the chance to conduct this study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors have declared that there are no conflicts of interest regarding the content of this work.