Background: 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.

Methods: 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 p-value < 0.05 was considered statistically significant.

Results: 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 (>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 = 1.003–1.057], systolic blood pressure (HR = 0.99, 95% CI = 0.975–1.000), serum creatinine (HR = 1.32, 95% CI = 1.056–1.643), Killip class > II (HR = 4.62, 95% CI = 2.502–8.523), ejection fraction <40% (HR = 2.75, 95% CI = 1.463–5.162), and STEMI (HR = 2.72, 95% CI = 1.006–4.261) were independent predictors of 30-day mortality.

Conclusions: 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.

背景：尽管发达国家已对急性冠状动脉综合征（ACS）的负担、危险因素和临床特征进行了广泛研究，但撒哈拉以南非洲地区的数据有限。因此，本研究旨在评估埃塞俄比亚三级医院收治的ACS患者的临床特征、治疗和30天死亡率。

方法：2018年3月15日至11月15日期间，共有181名埃塞俄比亚三级医院收治的ACS患者入组。按ACS亚型评估其临床特征、治疗情况和30天死亡率。Cox 比例风险模型用于确定 30 天全因死亡率的预测因子。Ap-值<0.05被认为具有统计显着性。

结果：大多数 (61%) ACS 患者因 ST 段抬高型心肌梗死 (STEMI) 入院。平均年龄为 56 岁，其中男性占多数（62.4%）。超过三分之二 (67.4%) 的患者在症状出现 12 小时后就诊。血脂异常（48%）和高血压（44%）是最常见的危险因素。院内双重抗血小板药物和他汀类药物的使用率很高（>90%），其次是β受体阻滞剂（81%）和血管紧张素转换酶抑制剂（ACEIs；72%）。仅 13 例（7.2%）接受了经皮冠状动脉介入治疗 (PCI) 晚期再灌注，并且没有患者接受早期再灌注治疗。30天全因死亡率为25.4%。在多变量 Cox 比例风险模型分析中，年龄较大[风险比 (HR) = 1.03，95% CI = 1.003–1.057]、收缩压（HR = 0.99，95% CI = 0.975–1.000）、血清肌酐（HR = 1.32，95% CI = 1.056–1.643)，Killip 分级 > II (HR = 4.62，95% CI = 2.502–8.523)，射血分数 <40% (HR = 2.75，95% CI = 1.463–5.162)，以及 STEMI （HR = 2.72，95% CI = 1.006–4.261）是 30 天死亡率的独立预测因子。

结论：30 天全因死亡率高得令人无法接受，这意味着迫切需要制定一项全国性计划，以减少院前延误、推广指南指导药物的使用以及增加再灌注治疗的机会。