Browsing by Author "Mutyaba, Arthur"

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    In-Hospital Mortality Outcomes of ST-Segment Elevation Myocardial Infarction: A Cross-Sectional Study from a Tertiary Academic Hospital in Johannesburg, South Africa
    (Journal of Cardiovascular Development and Disease, 2023-08-15) Ndaba , Lindokuhle; Mutyaba, Arthur; Mpanya, Dineo; Tsabedze,Nqoba
    In sub-Saharan Africa, the burden of atherosclerotic cardiovascular disease (ASCVD) is increasing. This study aimed to describe the clinical characteristics of patients with ST-segment elevation myocardial infarction (STEMI) and estimate the in-hospital all-cause mortality rate. We conducted a cross-sectional retrospective single-centre study of STEMI patients who underwent diagnostic coronary angiography with or without percutaneous coronary intervention (PCI) between January 2015 and December 2019. We compared demographic and clinical parameters between survivors and non-survivors with descriptive statistics. Univariable and multivariable logistic regression analyses were performed to determine the predictors of all-cause mortality. The study population consisted of 677 patients with a mean age of 55.5 ± 11.3 years. The in-hospital all-cause mortality rate was 6.2% [95% confidence interval (CI): 4.5–8.3%]. Risk factors for ASCVD included smoking (56.1%), hypertension (52.8%), dyslipidemia (40.0%), and a family history of coronary artery disease (32.7%). A pharmaco-invasive management strategy (treatment with thrombolytic therapy and PCI) was implemented in 36.5% of patients and reduced all-cause mortality risk (OR: 0.16; CI: 0.04–0.71, p = 0.015). The in-hospital all-cause mortality rate in STEMI patients was 6.2%, and a pharmaco-invasive management strategy proved to be an effective approach.
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    Remote Ischaemic Conditioning in STEMI Patients in Sub-Saharan AFRICA: Rationale and Study Design for the RIC-AFRICA Trial
    (Cardiovascular Drugs and Therapy, 2021-11-05) Lukhna, Kishal; Mutyaba, Arthur; Kiggundu, Brian; Variava, Ebrahim; Ntsekhe, Mpiko
    Despite evidence of myocardial infarct size reduction in animal studies, remote ischaemic conditioning (RIC) failed to improve clinical outcomes in the large CONDI-2/ERIC-PPCI trial. Potential reasons include that the predominantly low-risk study participants all received timely optimal reperfusion therapy by primary percutaneous coronary intervention (PPCI). Whether RIC can improve clinical outcomes in higher-risk STEMI patients in environments with poor access to early reperfusion or PPCI will be investigated in the RIC-AFRICA trial. The RIC-AFRICA study is a sub-Saharan African multi-centre, randomized, double-blind, sham-controlled clinical trial designed to test the impact of RIC on the composite endpoint of 30-day mortality and heart failure in 1200 adult STEMI patients without access to PPCI. Randomized participants will be stratified by whether or not they receive thrombolytic therapy within 12 h or arrive outside the thrombolytic window (12–24 h). Participants will receive either RIC (four 5-min cycles of inflation [20 mmHg above systolic blood pressure] and deflation of an automated blood pressure cuff placed on the upper arm) or sham control (similar protocol but with low-pressure inflation of 20 mmHg and deflation) within 1 h of thrombolysis and applied daily for the next 2 days. STEMI patients arriving greater than 24 h after chest pain but within 72 h will be recruited to participate in a concurrently running independent observational arm. The RIC-AFRICA trial will determine whether RIC can reduce rates of death and heart failure in higher-risk sub-optimally reperfused STEMI patients, thereby providing a low-cost, non-invasive therapy for improving health outcomes.