Armenian national registry of myocardial infarction (ARMI): preliminary nationwide prospective stemi data with early heart failure signals

Background

ST-segment elevation myocardial infarction (STEMI) is frequently complicated by acute and chronic heart failure (HF), substantially worsening short- and long-term prognosis. Early reperfusion and timely identification of patients at high risk for HF are essential to reducing morbidity and mortality. The Armenian National Registry of Myocardial Infarction (ARMI), initiated in December 2023, is the first nationwide, prospective, multicenter STEMI registry in Armenia.

Objectives

To assess in-hospital mortality in patients admitted with STEMI and to evaluate 30-day and 12-month cardiovascular and all-cause mortality and rehospitalization rates.

Methods

ARMI prospectively enrolled consecutive adults aged 18–93 years admitted with STEMI within 48 hours of symptom onset across 13 hospitals nationwide, including tertiary centers and regional hospitals. Clinical data were collected by trained investigators using a secure national REDCap database. Enrollment occurred between December 1, 2023, and July 1, 2025. All patients were followed for one year with assessments at 30 days and 12 months.

Results

Between December 1, 2023, and June 30, 2025, 2,222 patients were enrolled; the present analysis includes 1,392 patients with complete data. Of these, 1,129 (81.1%) were men and 263 (18.9%) were women. Percutaneous coronary intervention (PCI) was performed in 97% of patients, indicating high adherence to guideline-recommended reperfusion strategies.

Acute HF with Killip class 3–4 at presentation occurred in 8.0% of patients, consistent with rates reported in contemporary European and North American STEMI registries (6–10%). In-hospital mortality was higher in patients with Killip class 3–4 (9.0%) compared with the overall cohort (3.1%), with cardiovascular causes accounting for 91.0% of deaths. Reduced systolic function was strongly associated with mortality, as 62.5% of deceased patients had a left ventricular ejection fraction ≤40%.

At 1-year follow-up, HF hospitalization occurred in 13% of patients with Killip class 3–4 versus 36% in the overall cohort. One-year all-cause mortality was 8% in the total population and 32% among patients presenting with Killip class 3–4, confirming the strong prognostic impact of early HF severity.

Conclusions

In this preliminary analysis of a nationwide STEMI registry, acute HF at presentation occurred in 8% of patients and was associated with substantially higher in-hospital and 1-year mortality. Killip class 3–4 and early systolic dysfunction remained strong prognostic markers despite high primary PCI rates, underscoring the importance of early HF risk stratification in STEMI.