Assessment of optimal medical therapy, Clinical outcome and Associated Factors in patients with acute coronary syndrome at University of Gondar Comprehensive Specialized Hospital, North West Ethiopia, 2023

Abstract

Background: - Acute coronary syndrome is one of the most common diseases in the world, affecting 7 million people worldwide. There is limited data on the recent use of evidence-based optimal medical therapies and clinical outcomes after discharge in patients with ACS in Ethiopia. Objective: - To assess optimal medical therapy, clinical outcomes, and associated factors in patients with acute coronary syndrome at University of Gondar Comprehensive and Specialized Hospital, North West Ethiopia, 2022/23. Methods: - Retrospective follow up study was conducted from January 31, 2018, to February 1, 2023 and the data were collected using a systematic random sampling technique. A descriptive analysis was done. The study employed binary and multivariable logistic regression analysis to evaluate the correlation between various factors. The primary outcome was 5-year all-cause mortality. The secondary outcome was major adverse cardiac events which were defined as myocardial re-infarction, stroke, and heart failure. Cox's proportional hazard model and log-rank test were used to test if there were significant changes in all-cause mortality and major adverse cardiac events between different sets of predictor variables at discharge, and a 95% CI with a P-value <0.05 was used to evaluate statistical significance. Five-year all-cause mortality after discharge estimate was displayed by using Kaplan–Meier curves. Results: Among 422 patients with acute coronary syndrome [mean age, 61.56 (SD = 9.686) years; 54.7% male], of whom only 59.2% (250) received optimal medical therapy at discharge. Age ≥ 65, atrial fibrillation, chronic kidney diseases, and cardiogenic shock were negative independent predictors of optimal medical therapy. On the other hand, male sex was independently associated with the use of optimal medical therapy. All-cause mortality occurred in 16.6% (n = 70) and major adverse cardiac events occurred in 30.8% (n = 130) of patients with a 95% CI of 0.132-0.205 and 0.264-0.355, respectively. Multivariate analyses indicated that OMT was significantly associated with reduced all-cause mortality (aHR: 0.431, 95% CI: 0.222– 0.835; P = 0.013). Conclusion: This study revealed that the use of preventive optimal medical therapy in patients discharged with acute coronary syndrome was associated with a reduction in all-cause mortality. However, the use of this optimal medical therapy is suboptimal