Clinical outcomes and associated factors in patients who underwent percutaneous coronary intervention: a multicenter study in Ethiopia.

AIMS: This study aimed to evaluate the clinical outcomes and associated factors in patients who underwent percutaneous coronary intervention (PCI). METHODS: This five-year retrospective cross-sectional study analyzed data from 241 patients who underwent urgent and primary PCI. Outcome measures included in-hospital mortality, major adverse cardiac and cerebrovascular events (MACCEs), postprocedural complications, and survival rates. Data were analysed using the Statistical Package for Social Sciences version 25. Cox proportional hazard regression models were used to assess predictors of in-hospital mortality. Kaplan-Meier analysis and the log-rank test were used to assess the overall survival rates and median survival time and to compare the survival probability curves for independent predictors. Hazard ratios (HRs) and 95% confidence intervals (CIs) were presented. RESULTS: One hundred forty-two patients underwent elective PCI with drug-eluting stent implantation (75.1%) as the reperfusion method. The in-hospital mortality and non-fatal MACCE rates were 3.7% and 24.1%, respectively. The predictors of in-hospital mortality were female sex (AHR = 8.39, 95% CI: 1.20-58.68, p = 0.03), preprocedural obesity (AHR = 6.54, 95% CI: 1.10-40.60, p = 0.04), previous myocardial infarction (AHR = 9.68, 95% CI: 1.66-56.31, p = 0.01), chronic heart failure (AHR = 9.21, 95% CI: 1.38-61.78, p = 0.02), and a previous history of stroke (AHR = 18.99, 95% CI: 1.59-227.58, p = 0.02). Notably, this study reported a high one-year survival rate. CONCLUSION: Urgent and primary PCIs are critical interventions for patients with MI in Ethiopia, showing promising outcomes such as low in-hospital mortality and a high one-year survival rate. These findings underscore the importance of optimising access to PCI and related treatments to improve patient outcomes.

Anticoagulation Management in Patients Receiving Warfarin at Private Cardiac Centers in Addis Ababa, Ethiopia.

Introduction: Anticoagulants are the cornerstone therapy for thromboembolism prevention and treatment. Warfarin is the frequently prescribed drug and remains the oral anticoagulant of choice in low- and middle-income countries, including Ethiopia. It is a narrow therapeutic index drug that needs high-quality anticoagulation monitoring with frequent international normalization ratio (INR) testing. Objective: The study aimed to assess anticoagulation management with warfarin among adult outpatients at two selected private cardiac centers in Addis Ababa, Ethiopia. Methods: A hospital-based retrospective study design that enrolled 374 patients receiving warfarin was employed at two private cardiac centres in Addis Ababa, Ethiopia. The time in the therapeutic range (TTR) was calculated using the Rosendaal method. The data were analyzed using Statistical Package for Social Science version 25. Results: The mean age of the patients was 57 years, and 218 (58.3%) participants were females. Out of 3384 INR tests, 1562 (46.5%) were within the therapeutic range and the mean percentage of TTR was 47.24%. Only 25.67% of the patients spent their TTR ≥ 65%. The present study revealed that dose adjustments were required 1764 times. In non-therapeutic INR values of 1764 that required warfarin dose adjustment, 59.7% of the doses were adjusted. About 262 (70.1%) of co-prescribed medications had interaction with warfarin. Sixty-four patients (17.11%) experienced bleeding events. Conclusion: Anticoagulation management with warfarin was suboptimal in private cardiac Addis Ababa, Ethiopia, private cardiac centers. Warfarin adjustment practice for nontherapeutic INR values was not minimal, and many patients encountered bleeding during their course of therapy.

Factors Associated with the Extent of Coronary Artery Disease and the Attained Outcome of Percutaneous Coronary Intervention at Gesund Cardiac and Medical Center, Addis Ababa, Ethiopia.

Background: In Ethiopia, objective evidences showing pathologic features and clinical characteristics predicting the extent of coronary artery disease are scanty. The present study is aimed at assessing factors associated with the extent of coronary artery disease and the attained outcomes in patients undergoing percutaneous coronary intervention. Methods: A retrospective observational study of 197 patients that have undergone percutaneous coronary intervention was undertaken. Data were entered using Epi data version 4.2 and exported to Statistical Package for Social Science version 25 for analysis. Descriptive statistics such as frequencies and percentages were used to summarize the findings. Logistic regression was carried out to test the association between dependent and independent variables. Results: The mean age of the study participants was 58.6 with standard deviation (SD) of 11.5 and male to female ratio of 4.2. The majority, [110 (55.8%)], had ST segment elevation myocardial infarction. Nearly two-third of the study participants had documented heart failure. Dyslipidemia [AOR 4.2(95%; CI:1.29-14.00)] and left ventricular hypertrophy [AOR 4.1(95%; CI:1.38-12.40)] were associated with extent of coronary artery disease on adjusted analysis. In the large majority, 169 patients (85.8%), thrombolysis in myocardial infarction 3 flow grade was achieved. Conclusion: Dyslipidemia and left ventricular hypertrophy predicted multi-vessel coronary artery disease. There is a high frequency of post myocardial infarction heart failure, underscoring the need for centers of excellence and implementation of health education programs targeting the importance of primary prevention and timely revascularization. The success rate of percutasneous coronary intervention at Gesund Cardiac and Medical Center is praiseworthy.

The Management of Coronary Artery Disease in Ethiopia: Emphasis on Revascularization.

Cardiovascular diseases are number one cause of death worldwide. Over half of the cardiovascular diseases, 51%, are due to coronary artery disease. Coronary artery disease is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial coronary arteries. Rupture of the fibrous cap of the plaque causes the majority of the deaths due to myocardial infarction. Angina pectoris is a discomfort in the chest or adjacent areas caused by myocardial ischemia usually precipitated by exertion. In acute coronary syndrome, the chest discomfort is either of low threshold or appears at rest and when it evolves on the background of established angina pectoris, the discomfort becomes more frequent and prolonged. Exercise electrocardiography which has been the most frequently used non-invasive test to diagnose obstructive coronary artery disease is currently shown to have inferior diagnostic performance compared with diagnostic imaging tests. The pivotal tests in patients presenting with clinical features of acute coronary syndrome are electrocardiography and determination of serum troponin I and/or T. Revascularization is the mainstay of treatment in patients with acute coronary syndrome. In chronic coronary syndrome, on top of optimal medical treatment, revascularization reduces mortality in:- 1) left main stenosis, 2) three-vessel coronary artery disease, particularly with ejection fraction of less than 40%, 3) two vessel disease with more than 75% stenosis of the proximal left anterior descending coronary artery disease.