In-Hospital mortality and determinants among myocardial infarction patients in public hospitals, Northwest Ethiopia: evidence from sub-Saharan Africa

BACKGROUND: Myocardial infarction (MI) is a leading cause of death worldwide, and the burden is rising in low-resource settings such as Ethiopia. However, evidence on in-hospital outcomes and their predictors remains scarce in Northwest Ethiopia. OBJECTIVE: To determine the prevalence of in-hospital mortality among MI patients and identify associated factors in two referral hospitals in Bahir Dar, Ethiopia. METHODS: A retrospective cohort study was conducted using medical records of 317 patients admitted with MI between November 2020 and December 2023. Data were extracted with a structured checklist and analyzed using SPSS version 27. Multivariable logistic regression was applied to identify independent predictors, and adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported, and the statistical significance level was p < 0.05. RESULTS: The overall in-hospital mortality was 21.5% (95% CI: 16.6–25.9). Mortality was significantly higher among patients aged > 65 years (AOR = 6.85; 95% CI: 1.58–29.71), those with diabetes mellitus (AOR = 7.02; 95% CI: 2.47–19.91), STEMI (AOR = 5.75; 95% CI: 1.66–19.87), elevated troponin ≥ 5000 ng/ml (AOR = 9.98; 95% CI: 4.06–24.53), raised serum creatinine (AOR = 4.21; 95% CI: 1.47–12.08), and Killip class III/IV (AOR = 15.52; 95% CI: 5.19–46.46). CONCLUSION: In-hospital mortality among MI patients in Northwest Ethiopia is alarmingly high. Advanced age, diabetes, STEMI, renal dysfunction, elevated troponin, and higher Killip class were independent predictors. Strengthening early recognition, timely referral, and context-appropriate management strategies is essential to improve survival.