One-Year Survival and Predictors of Mortality in Patients with Acute Coronary Syndrome in Ethiopia: A Multi-center Retrospective Cohort Study (2024–2025)

Abstract

Abstract Background Acute coronary syndrome (ACS) is a leading cause of morbidity and mortality worldwide. In Ethiopia, in-hospital mortality is high (15–27%), but long-term survival data are lacking. This study aimed to determine one-year survival and identify predictors of mortality among ACS patients in Ethiopian tertiary and private cardiac centers. Methods A multi-center retrospective cohort study was conducted at two public tertiary hospitals (St. Paul's Hospital Millennium Medical College, Tikur Anbessa Specialized Hospital) and one private cardiac center (Gesund Cardiac Center) in Addis Ababa, Ethiopia. Adult patients (≥18 years) with a confirmed ACS diagnosis admitted between January 2024 and January 2025 were included. One-year all-cause mortality was ascertained through hospital records and telephone follow-up. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression were used to estimate survival and identify independent predictors of mortality. Results A total of 223 patients were enrolled. The one-year survival rate was 77.1% (95% CI: 70.3–82.1), corresponding to a 22.9% mortality rate (51 deaths). Guideline-directed medical therapy (GDMT) at discharge was prescribed in 69.5% of patients. Survival was significantly higher among patients adherent to GDMT at one year (mean 327.7 vs. 225.5 days, log-rank p<0.001). In multivariable analysis, independent predictors of one-year mortality were: non-adherence to GDMT (adjusted HR for adherent = 0.271; 95% CI 0.136–0.540; p<0.001), lower LVEF (HR per 1% increase = 0.965; 95% CI 0.936–0.995; p=0.022), wall motion abnormalities (HR = 1.334; 95% CI 1.074–1.658; p=0.009), in-hospital heart failure (HR = 2.449; 95% CI 1.106–5.426; p=0.027), in-hospital acute kidney injury (AKI) (HR = 2.439; 95% CI 1.241–4.791; p=0.010), and lack of ICU availability (HR for ICU available = 0.383; 95% CI 0.173–0.848; p=0.018). Cardiogenic shock showed a borderline effect (p=0.086). Age, sex, Killip class, PCI, and hospital type were not independently significant. Conclusions One-year mortality after ACS in Ethiopian cardiac centers remains high. Adherence to GDMT, higher LVEF, absence of wall motion abnormalities, avoidance of in-hospital heart failure and AKI, and ICU availability are independent predictors of better survival. Widespread implementation of GDMT and early risk stratification could substantially improve long-term outcomes. Keywords Acute coronary syndrome, one-year survival, predictors of mortality, guideline-directed medical therapy, Ethiopia, sub-Saharan Africa