MORTALITY RISK DETERMINANTS IN ACUTE CORONARY SYNDROME: AN EVIDENCE-BASED LITERATURE REVIEW

ika ainur rofiah; Rudi  Hariyono

doi:10.29082/IJNMS/2025/Vol9/Iss3/802

Authors

ika ainur rofiah Universitas Bina Sehat PPNI Mojokerto
Rudi Hariyono Universitas Bina Sehat PPNI Mojokerto

DOI:

https://doi.org/10.29082/IJNMS/2025/Vol9/Iss3/802

Keywords:

Acute Coronary Syndrome, Mortality Predictors, Risk Factors, Simple Risk Index

Abstract

Acute Coronary Syndrome (ACS) remains a major global health problem and a leading cause of mortality, particularly in low- and middle-income countries where delays in treatment and limited access to reperfusion persist. Early identification of mortality determinants is essential for optimizing management and improving outcomes. This evidence-based review aimed to summarize contemporary predictors of mortality in ACS, incorporating clinical, demographic, laboratory, and hemodynamic factors. A comprehensive search was conducted using PubMed, Scopus, and Google Scholar for articles published between 2017 and 2025. Eleven studies met the eligibility criteria and were synthesized narratively. The findings show that hemodynamic instability, including hypotension, tachycardia, and cardiogenic shock, is the most consistent predictor of early and in-hospital mortality. Renal impairment, high Killip class, reduced left ventricular ejection fraction, and cardiac arrest at presentation also substantially increase risk. Age and comorbidities such as diabetes, hypertension, and chronic kidney disease contribute to both short- and long-term mortality. System delays, including prolonged symptom-to-door and door-to-balloon times, further worsen outcomes, particularly in resource-limited settings. The Simple Risk Index (SRI) emerges as a practical early risk-stratification tool. Strengthening early recognition, ensuring timely reperfusion, and improving management of comorbidities are crucial steps to reduce ACS-related mortality

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References

Adam, A. A., & et al. (2021). Clinical Profile of Acute Coronary Syndrome Patients in Clinical Profile of Acute Coronary Syndrome Patients in Kupang: a Result from 1-Year iSTEMI Registry. Indonesian Journal of Cardiology, 42, 109–118. https://doi.org/10.30701/IJC.1098

Ardining, H., Niazta, A., & Karimullah, M. D. H. (2022). Factors Associated with In-hospital Mortality in Patients with Acute Coronary Syndrome. Heart Science Journal, 3(November 2021), 37–42. https://doi.org/10.21776/ub.hsj.2022.003.01.6

Arechkik, A. (2025). Acute Coronary Syndrome : A Retrospective Study of the Epidemiological and Evolutionary Profile of Patients Hospitalized at the Agadir Regional Hospital in Southern Morocco. 1–14. https://doi.org/10.2174/0118749445389857250530110431

Azzahra, F. N., & Adnan, N. (2023). Predictors of Mortality in Acute Coronary Syndrome Patients : A Literature Review. 03(12), 3324–3333.

Bergmark, B. A., Mathenge, N., Merlini, P. A., Lawrence-Wright, M. B., & Giugliano, R. P. (2022). Acute coronary syndromes. The Lancet, 399(10332), 1347–1358. https://doi.org/10.1016/S0140-6736(21)02391-6

Fanta, K., Daba, F. B., Asefa, E. T., Melaku, T., Chelkeba, L., Fekadu, G., & Gudina, E. K. (2021). Management and 30-Day Mortality of Acute Coronary Syndrome in a Resource-Limited Setting: Insight From Ethiopia. A Prospective Cohort Study. Frontiers in Cardiovascular Medicine, 8(September), 1–10. https://doi.org/10.3389/fcvm.2021.707700

Juzar, D. A., Muzakkir, A. F., Ilhami, Y. R., Taufiq, N., Pramudyo, M., Priyana, A., Anjarwani, S., Endang, J., & Widyantoro, B. (2022). Original Editorial Article. 43(Ii), 45–55. https://doi.org/10.30701/ijc.

Marfianti, E., Anwar, S., & Aryatama, A. B. (2020). Simple Risk Index Score and Hospitalization Mortality in Patients with ST-Elevation Myocardial Infarction. Green Medical Journal, 2(1), 1–7.

Meutia, R. S., & Nasution, S. A. (2017). Validity of Simple Risk Index and Evaluation of Methods andManagement of Acute Coronary Events to Predict Mortality inAcute Coronary Syndrome Patients in Intensive Coronary Uji Validasi Simple Risk Index dan Evaluation of Methods and Management of Acute C. Jurnal Penyakit Dalam Indonesia Volume, 4(4). https://doi.org/10.7454/jpdi.v4i4.146

Moriwaki, K., Kurita, T., Hirota, Y., Ito, H., Ishise, T., Fujimoto, N., Masuda, J., Ishikura, K., Tanigawa, T., Yamada, N., Kawasaki, A., & Dohi, K. (2023). Prognostic Impact of Prehospital Simple Risk Index in Patients With ST-Elevation Myocardial Infarction. Circulation Journal, 87(May), 629–639. https://doi.org/10.1253/circj.CJ-22-0795

Oraii, A., Kazemian, S., Shafeghat, M., Ashraf, H., Soleimani, A., Akrami, A., Balali, P., Danandeh, K., Fatahi, M., & Karbalai, S. (2024). Risk assessment for mortality in patients with ST ‐ elevation myocardial infarction undergoing primary percutaneous coronary intervention : A retrospective cohort study. February 2023. https://doi.org/10.1002/hsr2.1867

Pramudyo, M., Yahya, A. F., Martanto, E., Tiksnadi, B. B., Karwiky, G., Rafidhinar, R., Nastiti, G., & Putri, I. (2022). Predictors of In-Hospital Mortality in Patients with Acute Coronary Syndrome in Hasan Sadikin Hospital , Bandung , Indonesia : A Retrospective Cohort Study. 54(3), 379–388.

Rante, R. M., Arsita, E., & Oktavia, E. (2025). Prediktor Mortalitas Pasien Sindrom Koroner Akut di Rumah Sakit X Jakarta Periode September 2023-2024 Predictors of Mortality in Acute Coronary Syndrome Patients at Hospital X , Jakarta ( 2023 – 2024. 4(2), 126–130.

Song, C., Fu, R., Li, S., Yang, J., Wang, Y., Xu, H., Gao, X., Liu, J., Liu, Q., Wang, C., Dou, K., & Yang, Y. (2019). Simple risk score based on the China Acute Myocardial Infarction registry for predicting in-hospital mortality among patients with non-ST-segment elevation myocardial infarction : results of a prospective observational cohort study. 1–7. https://doi.org/10.1136/bmjopen-2019-030772

Szabo, G. T., & et al. (2021). Predictors of Hospital Mortality in Patients with Acute Coronary Syndrome Complicated by Cardiogenic Shock. Sensors, 21. https://doi.org/10.3390/s21030969

Ulvenstam, A., Graipe, A., Irewall, A. L., Söderström, L., & Mooe, T. (2023). Incidence and predictors of cardiovascular outcomes after acute coronary syndrome in a population ‑ based cohort study. Scientific Reports, 1–11. https://doi.org/10.1038/s41598-023-30597-w

Wahyuni, T., Fitriani, D. R., Harianto, J. W., & Ritanti, R. (2022). Cardiovascular Disease , Comorbidities , and Late Adult in Indonesia : a Cross- Sectional Population-Based National Survey. 18. https://doi.org/10.26714/mki.5.3.2022.208-215

Wita, W., Shariefuddin, A., Pramudyo, M., & Martha, J. W. (2024). Shock index creatinine : a new predictor of mortality in acute coronary syndrome patients. 4, 1–8.

Wiviott, S. D., Morrow, D. A., Frederick, P. D., Giugliano, R. P., Gibson, C. M., Mccabe, C. H., Cannon, C. P., Antman, E. M., & Braunwald, E. (2004). Performance of the Thrombolysis In Myocardial Infarction Risk Index in the National Registry of Myocardial Infarction-3 and -4 in ST-Segment Elevation Myocardial Infarction. Journal of the American College of Cardiology, 44(4), 783–789. https://doi.org/10.1016/j.jacc.2004.05.045

Yang, J., Zhang, R. U. ., LIU, F., Huo, Y., & Ge, J. (2024). Time and cause of death in patients after acute coronary syndrome. European Heart Journal, 45, 2024.

Zheng, W., Huang, X., Wang, X., Suo, M., Yan, Y., Gong, W., Ai, H., Que, B., & Nie, S. (2024). Impact of multimorbidity patterns on outcomes and treatment in patients. European Heart Journal Open, 4(2), 1–8. https://doi.org/10.1093/ehjopen/oeae009