Abstract
Background
Ischemic Heart Disease (IHD) is an emerging epidemic in sub-Saharan Africa (SSA). Despite the true burden underestimated in the African continent, it remains the leading cause of death among adults aged above 60 years. ST-Segment Elevation Myocardial Infarction (STEMI) is a clinically time-sensitive fatal sequela of IHD with timely reperfusion by primary Percutaneous Coronary Intervention (PCI) considered the gold standard of care. Tanzania has witnessed a gradual and continued development in the ability to provide coronary care and a simultaneous increase in risk factors associated with IHD. There is paucity of available data in the country.
Methodology
This single-center retrospective study was conducted at the Aga Khan Hospital Dar-es-Salaam (AKHD), Tanzania. The AKHD is one of the pioneers in establishing the first cardiac catheterization laboratory in the nation. The current study involved extracting relevant data of all patients who presented with STEMI from August 2014 to December 2023. Descriptive statistics were used to define the population. Patient’s outcomes were based on hospital survival. Binary logistic regression was run (at 95% CI and p-value < 0.05) to identify the determinants for in-hospital mortality.
Results
230 patients were included in the final analysis. The cohort was predominantly male (n=192,83.5%), with a median age was 55.0 years (IQR 48.0-65.0). Most patients presented with chest pain (n=162,72.6%), with a median duration of 12.2 hours (IQR 3.0-24.0 hours). The left Anterior descending (LAD) artery was the culprit vessel in most cases (n=112,48.7%). A total of 163(70.8%) patients underwent Primary-PCI. The in-hospital mortality of the cohort was 5.7%. When survivors and non-survivors were compared, a higher percentage of non-survivors were diabetic (n=12,92.3%), hypertensive (n=12,92.3%) and having a history of cigarette smoking(n=11,84.6%) (P- value <0.05). A higher mean BMI of 36.2 (±5.7) (OR 1.46, CI 1.17– 2.10), the presence of smoking (OR 41.68, CI 2.60– 240.71), and the need for mechanical ventilation (OR 77.42, CI 1.95– 128.89) were factors associated with in-hospital mortality.
Conclusion
Our study results demonstrate lower in-hospital mortality for STEMI patients compared to other regional studies. Cigarette smoking, obesity and the need for mechanical ventilation were predictors of poor in-hospital outcomes.