Clinical profiles, management, and outcomes of acute coronary syndrome patients in hospitals without reperfusion therapy: a multicentre study in Addis Ababa, Ethiopia

Acute coronary syndrome (ACS) is a leading cause of morbidity and mortality worldwide, disproportionately affecting low- and middle-income countries. Although ACS has been studied in Ethiopia, there is limited evidence on patients managed without reperfusion therapy, particularly across multiple tertiary public hospitals. This study aimed to assess the clinical profiles, in-hospital management, and outcomes of non-reperfused ACS patients in a multicentre Ethiopian setting. We conducted a multicentre retrospective study of adult ACS patients admitted to three tertiary public hospitals in Addis Ababa, Ethiopia, between February 25, 2023, and August 31, 2024, where reperfusion therapy was unavailable. All eligible patients were consecutively included. ACS included unstable angina, non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction, diagnosed based on ischemic symptoms, elevated troponins, ECG changes (new ST/T-wave changes, new left bundle branch block, or pathological Q-waves), and/or imaging evidence of myocardial injury or regional wall motion abnormalities. Clinical characteristics, management, and outcomes were extracted from electronic health records. Data were analyzed using SPSS version 26 and multivariable logistic regression was used to identify factors associated with in-hospital mortality (P < 0.05). A total of 154 ACS patients were included (mean age 58.4 ± 12.2 years; 63.6% male), with STEMI accounting for 79.9%. The median time from symptom onset to hospital arrival was 24 h (IQR 11.5–72.0). Chest pain (87.7%, typical in 53.2%) and shortness of breath (50.6%) were the most common presenting symptoms. Hypertension (55.2%) and diabetes (44.2%) were the most frequent comorbidities. Most patients received dual antiplatelet therapy (98.7%), statins (94.8%), and therapeutic anticoagulation (90.3%). The in-hospital mortality rate was 26.6%, with a median hospital stay of 8 days (IQR 4–10). Independent predictors of mortality were older age (AOR 1.04; 95% CI 1.00–1.09), female sex (AOR 3.90; 95% CI 1.40–10.93), higher respiratory rate (AOR 1.18; 95% CI 1.04–1.35), and lower systolic blood pressure (AOR 0.97; 95% CI 0.95–0.99). This study demonstrated a high rate of in-hospital mortality among ACS patients in hospitals without reperfusion therapies. Older age, female sex, higher respiratory rate, and lower systolic blood pressure were independently associated with mortality, emphasizing the importance of early risk assessment and vigilant monitoring of vital signs. Expanding the availability of thrombolysis, implementing structured prehospital ACS education programs, and establishing standardized ACS care pathways are imperative to achieving optimal outcomes in resource-limited settings.