Seven-day mortality and its predictors among patients with acute coronary syndrome in southwestern Ethiopia: A prospective cohort study

Abstract

Background: Acute coronary syndrome (ACS) remains a leading cause of cardiovascular morbidity and mortality worldwide, with particularly poor outcomes in low-resource settings. Contemporary prospective data on short-term outcomes and their predictors remain scarce in Ethiopia. This study aimed to describe the clinical characteristics of patients with ACS, determine seven-day mortality, and identify independent predictors of seven-day mortality at Jimma University Medical Center, Southwest Ethiopia. Methods: A prospective hospital-based cohort study was conducted among 200 consecutive adult patients admitted with ACS between September 2024 and September 2025. Sociodemographic, clinical, laboratory, electrocardiographic, echocardiographic, treatment, and outcome data were collected using a structured case report form. Seven-day mortality was the primary outcome. Kaplan–Meier analysis was used to estimate survival probabilities, and bivariable and multivariable logistic regression analyses were performed to identify independent predictors of seven-day mortality. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) are reported, and statistical significance was defined as p < 0.05. Results: Among the 200 participants, 75.5% were male and 61.5% were urban residents. The median age was 58 years (interquartile range [IQR], 48–68 years). ST-segment elevation myocardial infarction was the predominant ACS subtype (78.0%), followed by non–ST-segment elevation myocardial infarction (11.5%) and unstable angina (10.5%). Overall, 60 patients (30.0%) died within seven days of admission. After adjustment for potential confounders, diabetes mellitus (AOR, 17.93; 95% CI, 3.44–93.42; p = 0.001), advancing age (AOR, 1.23 per year; 95% CI, 1.11–1.38; p < 0.001), higher baseline troponin concentration (AOR, 1.41 ng/mL; 95% CI, 1.19–1.67; p < 0.001), and Killip class IV at presentation (AOR, 69.50; 95% CI, 4.54–1065.01; p = 0.002) were independently associated with increased odds of seven-day mortality. Conclusion: Seven-day mortality among patients with ACS at Jimma University Medical Center was substantial. Advancing age, diabetes mellitus, elevated baseline troponin, and Killip class IV independently predicted seven-day mortality. These findings underscore the importance of early risk stratification, prompt recognition of hemodynamic compromise, and timely implementation of evidence-based management strategies to improve short-term outcomes in resource-limited settings.