ACUTE CORONARY SYNDROME IN-HOSPITA MORTALITY AND ASSOCIATED FACTORS AMONG PATIENTS ADMITTED TO WOLKITE UNIVERSITY COMPREHENSIVE SPECIALIZED HOSPITAL, 2023-2026: A CROSS-SECTIONAL CHART REVIEW

Abstract

Background: Acute coronary syndrome remains a major cause of in-hospital mortality in low-resource settings, where access to reperfusion therapy and specialized cardiac care is limited. Evidence on determinants of outcomes in such contexts is scarce, particularly from non-revascularization centers in Ethiopia. Objective: To determine the magnitude of in-hospital mortality and identify its independent predictors among patients admitted with Acute Coronary Syndrome at Wolkite University Specialized Hospital, in the years 2023-2026; Wolkite Ethiopia. Methods: A cross-sectional chart review was conducted among 212 consecutive Acute Coronary Syndrome patients admitted between 2023 and 2026. Sociodemographic characteristics, clinical presentation, laboratory parameters, in-hospital complications, and outcomes were extracted using a structured checklist. The primary outcome was in-hospital mortality (died vs discharged alive). Bivariate logistic regression was performed to identify candidate predictors, followed by multivariable logistic regression using an events-per variable–guided approach. Model fitness was assessed using the Hosmer–Lemeshow test and pseudo R² statistics. Result: The overall in-hospital mortality rate was 16.1%, with substantially higher mortality among patients presenting with ST-segment elevation myocardial infarction. In multivariable analysis, Killip class IV at presentation [AOR=11], ST-segment elevation myocardial infarction diagnosis [AOR= 3.6], elevated serum creatinine indicating acute kidney injury (AOR ≈ 10), and composite in-hospital complications [AOR=14] were independently associated with in-hospital mortality. The final model demonstrated good fit (Hosmer Lemeshow, p = 0.718) and strong explanatory power (Nagelkerke R² = 0.73). Conclusion: In-hospital mortality among Acute Coronary Syndrome patients in our study was high and driven primarily by clinical severity and in-hospital complications. Early risk stratification and improved supportive care for high-risk patients are essential to improve outcomes in resource-limited settings.