Real-world management and outcomes of myocardial infarction in a transitional country: insights from an 11-year observational study of 13,099 patients.

BACKGROUND AND AIM: Acute myocardial infarction (AMI) remains a leading cause of death globally, despite substantial advances in prevention, diagnosis and reperfusion therapy. In transitional health systems, in-hospital mortality is higher due to limited reperfusion capacity and infrastructure limitations. Kosovo introduced primary percutaneous coronary intervention (PPCI) in 2014, achieving nationwide 24/7 coverage in 2018. We evaluated 11-year trends in AMI management in Kosovo and identified independent predictors of in-hospital mortality.

METHODS

We analyzed 13,099 consecutive patients hospitalized with AMI between 2014 and 2024 at Kosovo's main tertiary cardiology center. Patients were classified as ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI). Multivariable logistic regression was used to identify independent predictors of in-hospital mortality.

RESULTS

Patient's mean age was 63.8 ± 11.5 years, and 29% were women. STEMI accounted for 55% of cases. Overall in-hospital mortality was 9.0%, declining from 19.3% in 2014 to 7.7% in 2024. Mortality was higher in STEMI than NSTEMI (12% vs. 6%, p < 0.001). In multivariable analysis, cardiogenic shock, advanced age, female sex, reduced left ventricular ejection fraction, admission hyperglycaemia, and absence of PPCI were independently associated with higher mortality.

CONCLUSIONS

In-hospital AMI mortality in Kosovo declined substantially over 11 years, coinciding with the expansion of 24/7 PPCI. STEMI remained the highest-risk presentation, and cardiogenic shock was the dominant predictor of death. These findings highlight the critical importance of timely reperfusion and system-level strengthening of acute cardiac care in transitional healthcare settings.