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

Hiwot Alemu Admas,1 Kassaye Demeke Altaye,2 Desalew Getahun Ayalew,1 Nebiyu Mesfin1 ,† Aynishet Adane,1 Melaku Tadesse Abebe,1 Sead Hassen Abegaz,1 Getachew Sahile Alemu,1 Gebrehiwot Lema Legese1 1Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Emergency and Critical Care Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia†Dr Nebiyu Mesfin passed away on 17-May-2023Correspondence: Desalew Getahun Ayalew, Email [email protected]: 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

Keywords

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