INCIDENCE AND PREDICTORS OF RECURRENT ACUTE CORONARY SYNDROME AMONG ADULT ACUTE CORONARY SYNDROME PATIENTS IN WEST AMHARA COMPREHENSIVE SPECIALIZED HOSPITALS, AMHARA, NORTHWEST ETHIOPIA, 2022

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