Ten-year review of ST-Segment Elevation Myocardial Infarction (STEMI) in Tanzania: a single center retrospective review

Introduction: Ischemic Heart Disease (IHD) is an emerging epidemic in sub-Saharan Africa (SSA). Although the true burden may be underreported in the African continent, it still remains one of the leading causes 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) being the gold standard of care. There has been steady progress in coronary care services in Tanzania, alongside a rise in IHD-related risk factors. However, data on this is limited. This study aimed to examine trends in STEMI over the past decade and identify factors associated to in-hospital mortality. Methods: 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: two hundred and thirty (n=230) patients were included in the final analysis. The cohort was predominantly male (83.5%, n=192), with a median age of 55.0 years (IQR 48.0-65.0). More than half of the cohort were patients with Diabetes (56.9%, n=131) and hypertension (51.6%, n=111), presenting in Killip class I symptoms (54.3%, n=125). 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 (48.7%, n=112). A total of 163 (70.8%) patients underwent Primary-PCI. A mean BMI above 36.2 kg/m²(±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: the in-hospital mortality among patients with STEMI at our hospital was 5.7%. Cigarette smoking, obesity and the need for mechanical ventilation were predictors of poor in-hospital outcomes.