Determinants of in-Hospital Mortality Among Patients with Acute Coronary Syndrome at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: unmatched Case Control Study

Background: Acute coronary syndrome causes significant mortality and morbidity. Patients with acute coronary syndrome continue to have a significant in-hospital mortality rate. The evidence on factors contributing to in-hospital mortality in resource-limited setups remains scarce. The goal of this study was to assess determinants of in-hospital mortality among patients with ACS at University of Gondar Comprehensive Specialized Hospital; Northwest Ethiopia. Methods: An institution-based unmatched case-control study was conducted on admitted acute coronary syndrome patients from September, 2018 to May, 2022. We performed bi-variable logistic regression analysis followed by multivariable logistic regression analysis. P value < 0.05 and 95% CI were used to determine the association between independent variables and in-hospital mortality. Results: The study was conducted on 159 acute coronary syndrome patients, 53 cases and 106 controls. The mean ± SD age of the participants was 59.67 years ± 13.4 and 62.72 years ± 15.58 for controls and cases respectively. The determinants of in-hospital mortality were patients not initiated on B-blockers (AOR= 11.39, 95% CI: 2.32– 55.96), cardiogenic shock (AOR= 7.23, 95% CI: 1.56– 33.49), stroke (AOR = 7.61, 95% CI: 1.81– 31.92), oxygen saturation < 90% (AOR = 5.31, 95% CI: 1.25– 22.57) and hemoglobin level less than 12 g/dl (AOR=3.43, 95% CI: 1.13– 10.35). Conclusion: Patients not initiated on beta-blockers, development of cardiogenic shock and stroke, low oxygen saturation, and hemoglobin level below 12 g/dl were the determinants of in-hospital mortality. Therefore, early detection and treatment of complications and comorbidities should be routine practice to decrease the in-hospital mortality of patients with acute coronary syndrome. Keywords: determinants, acute coronary syndrome, in-hospital mortality, Ethiopia, resource limited setting