{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:33:47Z","timestamp":1777916027645,"version":"3.51.4"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T00:00:00Z","timestamp":1631836800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005068","name":"Jimma University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005068","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Despite the fact that the burden, risk factors, and clinical characteristics of acute coronary syndrome (ACS) have been studied widely in developed countries, limited data are available from sub-Saharan Africa. Therefore, this study aimed at evaluating the clinical characteristics, treatment, and 30-day mortality of patients with ACS admitted to tertiary hospitals in Ethiopia.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> A total of 181 ACS patients admitted to tertiary care hospitals in Ethiopia were enrolled from March 15 to November 15, 2018. The clinical characteristics, management, and 30-day mortality were evaluated by ACS subtype. The Cox proportional hazards model was used to determine the predictors of 30-day all-cause mortality. A <jats:italic>p<\/jats:italic>-value &amp;lt; 0.05 was considered statistically significant.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The majority (61%) of ACS patients were admitted with ST-segment elevation myocardial infarction (STEMI). The mean age was 56 years, with male predominance (62.4%). More than two-thirds (67.4%) of patients presented to hospital after 12 h of symptom onset. Dyslipidemia (48%) and hypertension (44%) were the most common risk factors identified. In-hospital dual antiplatelet and statin use was high (&amp;gt;90%), followed by beta-blockers (81%) and angiotensin-converting enzyme inhibitors (ACEIs; 72%). Late reperfusion with percutaneous coronary intervention (PCI) was done for only 13 (7.2%), and none of the patients received early reperfusion therapy. The 30-day all-cause mortality rate was 25.4%. On multivariate Cox proportional hazards model analysis, older age [hazard ratio (HR) = 1.03, 95% CI = 1.003\u20131.057], systolic blood pressure (HR = 0.99, 95% CI = 0.975\u20131.000), serum creatinine (HR = 1.32, 95% CI = 1.056\u20131.643), Killip class &amp;gt; II (HR = 4.62, 95% CI = 2.502\u20138.523), ejection fraction &amp;lt;40% (HR = 2.75, 95% CI = 1.463\u20135.162), and STEMI (HR = 2.72, 95% CI = 1.006\u20134.261) were independent predictors of 30-day mortality.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> The 30-day all-cause mortality rate was unacceptably high, which implies an urgent need to establish a nationwide program to reduce pre-hospital delay, promoting the use of guideline-directed medications, and increasing access to reperfusion therapy.<\/jats:p>","DOI":"10.3389\/fcvm.2021.707700","type":"journal-article","created":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T05:03:20Z","timestamp":1631855000000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":17,"title":["Management and 30-Day Mortality of Acute Coronary Syndrome in a Resource-Limited Setting: Insight From Ethiopia. A Prospective Cohort Study"],"prefix":"10.3389","volume":"8","author":[{"given":"Korinan","family":"Fanta","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fekede Bekele","family":"Daba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elsah Tegene","family":"Asefa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsegaye","family":"Melaku","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Legese","family":"Chelkeba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ginenus","family":"Fekadu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esayas Kebede","family":"Gudina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jacc.2017.04.052","article-title":"Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015","volume":"70","author":"Roth","year":"2017","journal-title":"J Am Coll Cardiol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1736","DOI":"10.1016\/S0140-6736(18)32203-7","article-title":"Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980\u20132017: a systematic analysis for the global burden of disease study 2017","volume":"392","author":"Roth","year":"2018","journal-title":"Lancet."},{"key":"B3","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1161\/CIRCRESAHA.116.309115","article-title":"Decline in cardiovascular mortality: possible causes and implications","volume":"120","author":"Mensah","year":"2017","journal-title":"Circ Res."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1161\/CIRCOUTCOMES.118.005375","article-title":"Mortality from ischemic heart disease: analysis of data from the world health organization and coronary artery disease risk factors from NCD risk factor collaboration","volume":"12","author":"Nowbar","year":"2019","journal-title":"Circ Cardiovasc Qual Outcomes."},{"key":"B5","doi-asserted-by":"publisher","first-page":"15","DOI":"10.5334\/gh.403","article-title":"Cardiovascular diseases in sub-saharan africa compared to high-income countries: an epidemiological perspective","volume":"15","author":"Yuyun","year":"2020","journal-title":"Glob Heart."},{"key":"B6","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1080\/14779072.2021.1855975","article-title":"Ischaemic heart disease, stroke, and their cardiometabolic risk factors in Africa: current challenges and outlook for the future","volume":"19","author":"Peer","year":"2021","journal-title":"Expert Rev Cardiovasc Ther."},{"key":"B7","doi-asserted-by":"publisher","first-page":"3554","DOI":"10.1161\/CIRCULATIONAHA.105.563452","article-title":"Risk factors associated with myocardial infarction in Africa: the INTERHEART Africa study","volume":"112","author":"Steyn","year":"2005","journal-title":"Circulation."},{"key":"B8","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1016\/j.acvd.2015.12.005","article-title":"Optimizing the management of acute coronary syndromes in sub-Saharan Africa: a statement from the AFRICARDIO 2015 Consensus Team","volume":"109","author":"Kakou-Guikahue","year":"2016","journal-title":"Arch Cardiovasc Dis."},{"key":"B9","doi-asserted-by":"publisher","first-page":"365","DOI":"10.5830\/CVJA-2012-017","article-title":"Management of acute coronary syndrome in South Africa: insights from the ACCES (Acute coronary events - a multinational survey of current management strategies) registry","volume":"23","author":"Schamroth","year":"2012","journal-title":"Cardiovasc J Afr."},{"key":"B10","first-page":"269","article-title":"Characteristics and management of patients with acute coronary syndrome at Tikur Anbessa Specialized Hospital, Addis Ababab, Ethiopia","volume":"51","author":"Giday","year":"2013","journal-title":"Ethiop Med J."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0228953","article-title":"Treatment outcome of acute coronary syndrome patients admitted to ayder comprehensive specialized hospital, mekelle, Ethiopia; a retrospective cross-sectional study","volume":"15","author":"Desta","year":"2020","journal-title":"PLoS One."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1179546819839417","DOI":"10.1177\/1179546819839417","article-title":"Treatment outcomes of patients with acute coronary syndrome admitted to Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia","volume":"13","author":"Bogale","year":"2019","journal-title":"Clin Med Insights Cardiol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1581","DOI":"10.1016\/j.jacc.2012.08.001","article-title":"Third universal definition of myocardial infarction","volume":"60","author":"Thygesen","year":"2012","journal-title":"J Am Coll Cardiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s12873-021-00433-3","article-title":"Management quality indicators and in-hospital mortality among acute coronary syndrome patients admitted to tertiary hospitals in Ethiopia: prospective observational study","volume":"21","author":"Fanta","year":"2021","journal-title":"BMC Emerg Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.jacc.2012.11.019","article-title":"2013 ACCF\/AHA guideline for the management of st-elevation myocardial infarction: a report of the American college of cardiology foundation\/american heart association task force on practice guidelines","volume":"61","author":"O'Gara","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e139","DOI":"10.1016\/j.jacc.2014.09.017","article-title":"2014 AHA\/acc guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines","volume":"64","author":"Amsterdam","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1016\/S0002-9149(02)02489-X","article-title":"Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the global registry of acute coronary events (GRACE)","volume":"90","author":"Steg","year":"2002","journal-title":"Am J Cardiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1016\/j.ahj.2011.07.029","article-title":"Management of acute coronary syndromes in developing countries: acute coronary events-a multinational survey of current management strategies","volume":"162","author":"Montalescot","year":"2011","journal-title":"Am Heart J."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12872-019-1043-1","article-title":"Medium and long-term follow-up after ST-segment elevation myocardial infarction in a sub-Saharan Africa population: a prospective cohort study","volume":"19","author":"Yao","year":"2019","journal-title":"BMC Cardiovasc Disord."},{"key":"B20","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.ahj.2006.10.004","article-title":"Global registry of acute coronary events (GRACE) hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome","volume":"153","author":"Tang","year":"2007","journal-title":"Am Heart J."},{"key":"B21","doi-asserted-by":"publisher","first-page":"2285","DOI":"10.1093\/eurheartj\/ehl196","article-title":"The second euro heart survey on acute coronary syndromes: characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004","volume":"27","author":"Mandelzweig","year":"2006","journal-title":"Eur Heart J."},{"key":"B22","doi-asserted-by":"publisher","first-page":"225","DOI":"10.5830\/CVJA-2018-017","article-title":"Presentation, management and outcomes of acute coronary syndrome: a registry study from Kenyatta National Hospital in Nairobi, Kenya","volume":"29","author":"Bahiru","year":"2018","journal-title":"Cardiovasc J Afr."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1435","DOI":"10.1016\/S0140-6736(08)60623-6","article-title":"Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data","volume":"371","author":"Xavier","year":"2008","journal-title":"Lancet."},{"key":"B24","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1093\/eurheartj\/ehs219","article-title":"Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS registry","volume":"34","author":"Mohanan","year":"2013","journal-title":"Eur Heart J."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1959","DOI":"10.1161\/CIRCRESAHA.114.302782","article-title":"Global perspective on acute coronary syndrome: a burden on the young and poor","volume":"114","author":"Vedanthan","year":"2014","journal-title":"Circ Res."},{"key":"B26","doi-asserted-by":"publisher","first-page":"146","DOI":"10.2174\/1874192401711010146","article-title":"Khat (Catha Edulis) as a risk factor for cardiovascular disorders: systematic review and meta-analysis","volume":"11","author":"Mega","year":"2017","journal-title":"Open Cardiovasc Med J."},{"key":"B27","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1111\/j.1365-2125.2005.02358.x","article-title":"Khat chewing is a risk factor for acute myocardial infarction: a case-control study","volume":"59","author":"Al-Motarreb","year":"2005","journal-title":"Br J Clin Pharmacol."},{"key":"B28","unstructured":"Ethiopia Demographic and Health Survey 20162016"},{"key":"B29","doi-asserted-by":"publisher","first-page":"974","DOI":"10.4065\/mcp.2010.0398","article-title":"Association of khat chewing with increased risk of stroke and death in patients presenting with acute coronary syndrome","volume":"85","author":"Ali","year":"2010","journal-title":"Mayo Clin Proc."},{"key":"B30","doi-asserted-by":"publisher","first-page":"9","DOI":"10.5144\/0256-4947.2012.9","article-title":"Baseline characteristics, management practices, and long-term outcomes of Middle Eastern patients in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2)","volume":"32","author":"AlHabib","year":"2012","journal-title":"Ann Saudi Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"2699","DOI":"10.1093\/eurheartj\/ehy373","article-title":"Cardiology services in Ethiopia","volume":"39","author":"Leuner","year":"2018","journal-title":"Eur Heart J."},{"key":"B32","doi-asserted-by":"publisher","first-page":"2345","DOI":"10.1001\/archinte.163.19.2345","article-title":"Predictors of hospital mortality in the global registry of acute coronary events","volume":"163","author":"Granger","year":"2003","journal-title":"Arch Intern Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1016\/j.ahj.2009.06.010","article-title":"Validation of the global registry of acute coronary event (GRACE) risk score for in-hospital mortality in patients with acute coronary syndrome in Canada","volume":"158","author":"Elbarouni","year":"2009","journal-title":"Am Heart J."},{"key":"B34","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1016\/S1885-5857(10)70138-9","article-title":"Validation of the GRACE risk score for predicting death within 6 months of follow-up in a contemporary cohort of patients with acute coronary syndrome","volume":"63","author":"Abu-Assi","year":"2010","journal-title":"Rev Espa\u00f1ola Cardiol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1177\/0003319710387921","article-title":"Validation of the GRACE risk score for hospital mortality in patients with acute coronary syndrome in the Arab Middle East","volume":"62","author":"Yusufali","year":"2011","journal-title":"Angiology."},{"key":"B36","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.ijcard.2019.02.043","article-title":"Predictive ability of ACEF and ACEF II score in patients undergoing percutaneous coronary intervention in the GLOBAL LEADERS study","volume":"286","author":"Chichareon","year":"2019","journal-title":"Int J Cardiol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1167","DOI":"10.1016\/j.amjcard.2015.02.001","article-title":"Prognostic value of the age, creatinine, and ejection fraction score for 1-year mortality in 30-day survivors who underwent percutaneous coronary intervention after acute myocardial infarction","volume":"115","author":"Lee","year":"2015","journal-title":"Am J Cardiol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.ijcard.2018.05.134","article-title":"Predictive value of the age, creatinine, and ejection fraction (ACEF) score in patients with acute coronary syndromes","volume":"270","author":"St\u00e4hli","year":"2018","journal-title":"Int J Cardiol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1002\/ccd.26325","article-title":"2015 ACC\/AHA\/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial Infarction: an update of the 2011 ACCF\/AHA\/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF\/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions","volume":"87","author":"Levine","year":"2016","journal-title":"Catheter Cardiovasc Interv"},{"key":"B40","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur Heart J."},{"key":"B41","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects","volume":"310","year":"2013","journal-title":"JAMA"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.707700\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T03:01:30Z","timestamp":1633834890000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.707700\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,17]]},"references-count":41,"alternative-id":["10.3389\/fcvm.2021.707700"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2021.707700","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,17]]},"article-number":"707700"}}