Date of Award

5-30-2016

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Mohamed Jeilan

Second Supervisor/Advisor

Dr. Anders Barasa

Third Supervisor/Advisor

Dr. Mzee Ngunga

Department

Internal Medicine (East Africa)

Abstract

Background: As the prevalence of cardiovascular diseases in Sub-Saharan Africa rises, coronary artery disease, with its acute presentations, is being increasingly recognized in Kenyans and treated at tertiary level hospitals. It is just over a decade since the introduction and wide availability of modern cardiology services, including interventional cardiology in Kenya.

Following an acute coronary syndrome (ACS), patients remain at high risk of death and other adverse events such as heart failure, recurrent myocardial infarction, stroke, and bleeding. Local and regional data on long-term outcomes following ACS are lacking. These data are important to clinicians for prognostication and to health care planners for resources allocation.

Objectives: The objectives of this study were to determine the in-hospital and long-term outcomes of patients following the treatment of Acute Coronary Syndromes. Specific objectives included determining in-hospital, 30-day and one-year mortality of ACS patients, and the rates of several non-fatal adverse outcomes including reinfarction, heart failure and cardiogenic shock, revascularization, stroke, major bleeding and re-hospitalization due to specific major adverse events.

Methods: The study was a retrospective chart review of ACS admissions during a two year period (2012-2013) for all acute coronary syndrome admissions. Data on patient characteristics, treatment, and inpatient and short-term outcomes were obtained from the patients’ medical records. Telephone interviews were conducted to determine long-term results.

Results: A total of 230 patients were included in the analysis. Of these, 101 had a diagnosis of STEMI, 93 suffered an NSTEMI, and 36 had UA. Males accounted for 81.7% of the patients, and the mean age was 60.5 years. Delayed presentation was common with more than 35% of patients taking longer than 24 hours to arrive. Coronary angiography was performed in 85.2% of the patients. The in-hospital mortality was 7.8% (14.9% for STEMI and 2.3% for NSTE-ACS), the mortality at 30 days and one year was 7.8% and 13.9% respectively. The most common in-hospital non-fatal adverse outcome was heart failure, occurring in 40.4% of STEMI and 16.3% of NSTE-ACS. Readmission rate due to recurrent MI, stroke or bleeding at one year was 6.6%.

Conclusion: In our cohort, in-hospital, 30 day and one year mortality following acute coronary syndromes remains high, particularly for STEMI. Delayed presentation to hospital following the onset of symptoms appears to be an important contributing factor.

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