In-Hospital Mortality Outcomes of ST-Segment Elevation Myocardial Infarction: A Cross-Sectional Study from a Tertiary
Lindokuhle Ndaba1, Arthur Mutyaba1, Dineo Mpanya1
1Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa.
Insights
In sub-Saharan Africa, atherosclerotic cardiovascular disease (ASCVD) is rising. A pharmaco-invasive strategy significantly reduced in-hospital mortality for ST-segment elevation myocardial infarction (STEMI) patients.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Sub-Saharan Africa faces a growing burden of atherosclerotic cardiovascular disease (ASCVD).
- ST-segment elevation myocardial infarction (STEMI) is a critical manifestation of ASCVD.
- Understanding STEMI patient characteristics and outcomes in this region is vital.
Purpose of the Study:
- To describe clinical features of STEMI patients in sub-Saharan Africa.
- To estimate the in-hospital all-cause mortality rate for STEMI.
- To identify predictors of mortality and evaluate management strategies.
Main Methods:
- Retrospective, cross-sectional, single-center study of 677 STEMI patients (Jan 2015-Dec 2019).
- Data collected on demographics, clinical parameters, and risk factors.
- Statistical analyses included descriptive statistics, univariable, and multivariable logistic regression.
Main Results:
- The in-hospital all-cause mortality rate was 6.2%.
- Prevalent ASCVD risk factors included smoking (56.1%), hypertension (52.8%), and dyslipidemia (40.0%).
- A pharmaco-invasive strategy (thrombolysis + PCI) reduced mortality risk (OR: 0.16; p=0.015).
Conclusions:
- STEMI poses a significant mortality risk in sub-Saharan Africa.
- A pharmaco-invasive management approach is effective in reducing STEMI-related mortality.
- Targeting modifiable risk factors like smoking and hypertension is crucial.
Abstract:
In sub-Saharan Africa, the burden of atherosclerotic cardiovascular disease (ASCVD) is increasing. This study aimed to describe the clinical characteristics of patients with ST-segment elevation myocardial infarction (STEMI) and estimate the in-hospital all-cause mortality rate. We conducted a cross-sectional retrospective single-centre study of STEMI patients who underwent diagnostic coronary angiography with or without percutaneous coronary intervention (PCI) between January 2015 and December 2019. We compared demographic and clinical parameters between survivors and non-survivors with descriptive statistics. Univariable and multivariable logistic regression analyses were performed to determine the predictors of all-cause mortality. The study population consisted of 677 patients with a mean age of 55.5 ± 11.3 years. The in-hospital all-cause mortality rate was 6.2% [95% confidence interval (CI): 4.5-8.3%]. Risk factors for ASCVD included smoking (56.1%), hypertension (52.8%), dyslipidemia (40.0%), and a family history of coronary artery disease (32.7%). A pharmaco-invasive management strategy (treatment with thrombolytic therapy and PCI) was implemented in 36.5% of patients and reduced all-cause mortality risk (OR: 0.16; CI: 0.04-0.71, p = 0.015). The in-hospital all-cause mortality rate in STEMI patients was 6.2%, and a pharmaco-invasive management strategy proved to be an effective approach.
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