Clinical spectrum and outcomes of acute myocardial infarction: evidence from a multicenter study

Abstract

Acute myocardial infarction (AMI) is one of the severe clinical conditions where mortality and morbidity are higher in resource-limited settings, where percutaneous coronary intervention/fibrinolysis are not available or inadequate, such as in Ethiopia. However, data on the clinical spectrum and treatment outcomes of AMI in this region are scarce, and this study aimed to address these gaps. This study aims to evaluate the clinical profiles and treatment outcomes (death, improvement, or referral) of patients with AMI and to identify predictors. A retrospective observational chart review study was conducted among AMI patients from January 9, 2018, to August 31, 2023. A census of eligible records was applied to recruit participants. Logistic regression analysis was performed to identify associated factors, and variables having p-values < 0.05 were considered statistically significant. A total of 206 individuals’ charts with a diagnosis of AMI were reviewed. The hospital mortality rate was 18.4%, and ST-Elevation Myocardial Infarction (STEMI) was the most frequent diagnosis (72.8%). The median age of the patients was 53.9 years (IQR: 47.6–56.8 years). Over 78% of the patients had elevated cardiac biomarkers, and 35.9% had an ejection fraction (EF) of 40% or less. Aspirin was the most commonly prescribed medication (81.6%), followed by statins (80%). Comorbid hypertension (AOR = 3.52, 95% CI 2.09–5.95; P = 0.01), ejection fraction <50% (AOR = 4.3, 95% CI 2.10–10.05; P < 0.001), and STEMI (AOR = 2.7, 95% CI 1.3–7.2; P = 0.03) were independent predictors of in-hospital mortality. On the other hand, younger age (< 45 years: AOR = 0.39, 95% CI 0.27–0.56; P = 0.03; 45–54 years: AOR = 0.56, 95% CI 0.23–0.91; P = 0.041), Killip class I (AOR = 0.17, 95% CI 0.03–0.80; P = 0.015), Killip class II (AOR = 0.31, 95% CI 0.02–0.74; P = 0.012), and arrival within 12 h of symptom onset (AOR = 0.37, 95% CI 0.10–0.87; P = 0.01) were independently associated with a lower risk of in-hospital mortality. This study revealed a high in-hospital mortality rate among AMI patients, with a considerable proportion of patients having severe cardiac dysfunction, as evidenced by low ejection fraction and elevated biomarkers. In-hospital death had significant predictors such as advanced age, comorbid hypertension, Killip class IV, low ejection fraction, STEMI, and late arrival to the health facility. Over the past decade, developed countries have seen significant improvements in mortality and morbidity from cardiovascular events. However, there is limited evidence on the extent of this issue in low- and middle-income countries, particularly in Ethiopia. This multicenter retrospective chart review revealed a high rate of in-hospital mortality among AMI in Ethiopia, with most cases diagnosed as STEMI. The high rate of in-hospital mortality in AMI is characterized by severe cardiac dysfunction, low ejection fraction, and elevated biomarkers. Determining this risk is important given AMI co-morbid with hypertension, potential for early treatment intervention, improved acute cardiac care, and primary preventative strategies.