Department of Clinical Pharmacy, Institute of Health, Jimma University, P.O.Box: 378, Jimma, Oromia, Ethiopia.
Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia.
BMC Emerg Med. 2021 Mar 31;21(1):41. doi: 10.1186/s12873-021-00433-3.
Acute coronary syndrome (ACS) remains the leading cause of cardiovascular disease mortality and morbidity worldwide. While the management quality measures and clinical outcomes of patients with ACS have been evaluated widely in developed countries, inadequate data are available from sub-Saharan Africa countries. So, this study aimed to assess the clinical profiles, management quality indicators, and in-hospital outcomes of patients with ACS in Ethiopia.
A Prospective observational study was conducted at two tertiary hospitals in Ethiopia from March 2018 to November 2018. The primary outcome of the study was in-hospital mortality. Data were analyzed using SPSS version 23.0. Multivariable cox-regression was conducted to identify predictors of time to in-hospital mortality. Variable with p -value < 0.05 was considered statistically significant.
Among 181 ACS patients enrolled, about (61%) were presented with ST-elevation myocardial infarction (STEMI). The mean age of the study participant was 55.8 ± 11.9 years and 62.4% were males. The use of guideline-directed medications within 24 h of hospitalization were sub-optimal (57%) [Dual antiplatelet (73%), statin (74%), beta-blocker (67%) and ACEI (61%)]. Only (7%) ACS patients received the percutaneous coronary intervention (PCI). Discharge aspirin and statin were high (> 90%) while other medications were sub-optimal (< 80%). The all-cause in-hospital mortality rate was 20.4% and the non-fatal MACE rate was 25%. Rural residence (AHR: 3.64, 95% CI: 1.81-7.29), symptom onset to hospital arrival > 12 h (AHR: 4.23, 95% CI: 1.28-13.81), and Cardiogenic shock (AHR: 7.20, 95% CI: 3.55-14.55) were independent predictors of time to in-hospital death among ACS patients.
In the present study, the use of guideline-directed in-hospital medications was sub-optimal. The overall in-hospital mortality rate was unacceptably high and highlights the urgent need for national quality-improvement focusing on timely initiation of evidence-based medications, reperfusion therapy, and strategies to reduce pre-hospital delay.
急性冠状动脉综合征（ACS）仍然是全球心血管疾病死亡和发病的主要原因。虽然发达国家已经广泛评估了 ACS 患者的管理质量指标和临床结局，但来自撒哈拉以南非洲国家的数据不足。因此，本研究旨在评估埃塞俄比亚 ACS 患者的临床特征、管理质量指标和住院结局。
2018 年 3 月至 2018 年 11 月，在埃塞俄比亚的两家三级医院进行了一项前瞻性观察性研究。本研究的主要结局是住院期间死亡率。使用 SPSS 版本 23.0 分析数据。采用多变量 Cox 回归分析确定住院期间死亡率的时间预测因素。具有 p 值<0.05 的变量被认为具有统计学意义。
在纳入的 181 例 ACS 患者中，约 61%表现为 ST 段抬高型心肌梗死（STEMI）。研究参与者的平均年龄为 55.8±11.9 岁，62.4%为男性。住院 24 小时内使用指南指导的药物治疗并不理想（57%）[双联抗血小板（73%）、他汀类药物（74%）、β受体阻滞剂（67%）和 ACEI（61%）]。只有 7%的 ACS 患者接受了经皮冠状动脉介入治疗（PCI）。出院时阿司匹林和他汀类药物的使用率很高（>90%），而其他药物的使用率较低（<80%）。全因住院期间死亡率为 20.4%，非致命性主要不良心血管事件（MACE）发生率为 25%。农村居住（AHR：3.64，95%CI：1.81-7.29）、症状发作至入院时间>12 小时（AHR：4.23，95%CI：1.28-13.81）和心源性休克（AHR：7.20，95%CI：3.55-14.55）是 ACS 患者住院期间死亡时间的独立预测因素。
在本研究中，指南指导的住院药物治疗的使用率不理想。总体住院死亡率高得令人无法接受，这突显了迫切需要开展全国性的质量改进工作，重点是及时启动基于证据的药物治疗、再灌注治疗以及减少院前延迟的策略。
