Abstract:
Abstract
Introduction: Acute coronary syndrome is the most common cause of morbidity and mortality
in patients with coronary heart disease. Furthermore, recurrence of this problem is seen with high
adverse outcomes in studies in different parts of the world. However, in Ethiopia, there is no
enough information regarding to this problem, hence this study assess the incidence rate and its
predictors of recurrence among adult acute coronary syndrome patients in Ethiopia.
Objective: The study aimed to assess the incidence and predictors of recurrence among adult
acute coronary syndrome admitted in West Amhara Comprehensive specialized hospitals.
Methods: A retrospective follow-up study was conducted among 469 primary acute coronary
syndrome patients admitted to West Amhara Comprehensive Specialized Hospitals from January
01, 2017- December 31, 2021. A pre-tested structured data extraction tool was used to collect
data from the patient chart. Data was entered into EPi-info version 7 and exported to STATA
version 14 statistical software for analysis. The Weibull regression analysis model was
implemented and the effect size measured with an adjusted hazard ratio with 95% CI at P-value
< 0.05 was inferred as statistically significant.
Result: A total of 429 patients were used in the final analysis (average age, 60±13.9 years; and
245 (57.1%) men). A total of 53 patients (12.35%; 95%CI: 9.55 -15.83%) had a recurrent acute
coronary syndrome. The overall risk time was 93914 days (3130.47 months), and the recurrence
rate was 17/1000 patients per month. Multivariable weibull regression analyses revealed that,
predictors of recurrent acute coronary syndrome were its typical symptoms (syncope (hazard
ratio (HR): 3.54, P= 0.013), fatigue (HR: 5.23, P=<0.001)), history of chronic kidney disease,
(hazard ratio (HR): 8.22, P<0.001), left ventricular ejection fraction <40% (HR: 2.34, P=0.009),
not taking in-hospital treatments (aspirin (HR: 9.22, P<0.001), clopidogrel (HR: 4.11, p=0.001),
statins (HR: 2.74, p= 0.012)), and medication at discharge (statins (HR: 4.56, p= <0.001).
Conclusion: we found a higher incidence rate of recurrent acute coronary syndrome and the
major predictors for this higher recurrence rate were baseline typical symptoms, history of
chronic kidney disease, not prescribing anti-ischemic treatments. Hence, guideline-recommended
anti-ischemic treatment implementation should be strengthened.
Keywords: Parametric Model, Predictors, Recurrent acute coronary syndrome, Survival
Analysis, Weibull Regression Model
