Seven-day mortality and its predictors among patients with acute coronary syndrome in southwestern Ethiopia: A prospective cohort study

Figures

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  Figure 1.. CONSORT flow diagram. Flow diagram of patient enrollment and follow-up in the study of Acute Coronary Syndrome (ACS) at Jimma University Medical Center, Southwest Ethiopia (September 2024–September 2025). A total of 250 patients were assessed for ACS. Fifty were excluded due to prior coronary artery disease (n = 32) or declined consent (n = 18). Two hundred patients were enrolled and followed for seven days. Of these, 140 survived, and 60 died within the seven-day observation period. All enrolled patients were included in the final analysis.

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  Figure 2.. Demographic distribution of ACS patients admitted to Jimma University Medical Center, Southwest Ethiopia, 2025. The figure presents the age, sex, and residence profiles of the study population. The bar chart shows that most patients were aged 45 years and above, while the pie charts demonstrate a predominance of male participants (75.5%) and urban residents (61.5%). Together, these charts highlight that ACS primarily affected older, urban male patients in the study setting.

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  Figure 3.. Clinical characteristics of ACS patients in this study. (Stacked bar chart shows distribution of Killip classes across ACS types. Bar chart shows duration of symptoms before hospital presentation.

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  Figure 3b.. Clinical characteristics of ACS patients at Jimma University Medical Center, Southwest Ethiopia, 2025. The heatmap illustrates the distribution of Killip classes across ACS types and the duration of symptoms before hospital presentation, highlighting patterns of clinical severity and delays in care-seeking.

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  Figure 4.. Adjusted odds ratios for 7-day mortality in ACS patients at Jimma University Medical Center, Southwest, Ethiopia, 2025. The forest plot displays independent predictors of early mortality, highlighting age, diabetes mellitus, elevated troponin, and Killip Class IV as significant risk factors.

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  Figure 5.. Kaplan–Meier survival curves for 7-day mortality according to diabetes mellitus status among ACS patients.

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  Figure 6.. Kaplan–Meier Survival Curves by Killip Class for 7-Day Mortality in ACS patients. Four distinct curves represent Killip classes I (green), II (yellow), III (orange), and IV (red). Survival probability declined progressively with increasing Killip class, demonstrating the strong association between clinical severity and early mortality. Patients in Killip I maintained high survival (>90%) throughout the seven days, while those in Killip IV experienced a rapid decline, reaching near-zero survival by day 3. The log-rank test (p < 0.001) confirmed statistically significant differences across classes.

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  Figure 6b.. Violin plots of survival time distributions by Killip class and symptom duration distributions by ACS type. The plots illustrate variability and density patterns, highlighting shorter and more clustered survival in higher Killip classes and differences in care-seeking behavior across ACS types.

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  Figure 7.. Boxplots and density plots of age, troponin levels and systolic BP in ACS patients in this study.

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  Figure 8.. Pearson correlation matrix showing the relationships among six continuous clinical variables included in the multivariable analysis: age, left ventricular ejection fraction (LVEF), serum creatinine, NT-proBNP, systolic blood pressure (SBP), and heart rate (HR). Color intensity represents the magnitude and direction of the correlation coefficient, with blue indicating positive correlations and red indicating negative correlations.

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  Figure 9.. Receiver operating characteristic (ROC) curve demonstrating the discriminative performance of the multivariate prognostic model for predicting 7-day mortality among ACS patients. AUC = 0.967 (95% CI [0.950–0.989]).