Real-world management and outcomes of myocardial infarction in a transitional country: insights from an 11-year observational study of 13,099 patients
G Bajraktari, D Morina, B Kryeziu, A Luzha, A Poniku, P Ibrahimi, A Batalli, E Pllana-Pruthi, E Haliti, S EleziAbstract
Background and Aim
Acute myocardial infarction (AMI) remains a leading cause of death globally. In transitional health systems, in-hospital mortality is higher due to limited reperfusion capacity and infrastructure. Kosovo, a lower-middle-income country, introduced primary percutaneous coronary intervention (PCI) in 2014, expanding to 24/7 service by 2018. We assessed eleven-year trends in AMI management and in-hospital mortality in Kosovo and identified independent mortality predictors.
Methods
We analyzed 13,099 AMI patients treated from 2014–2024 at our cardiology center. Cases were categorized as ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI). Patient demographics, treatments, and in-hospital outcomes were collected. Multivariable logistic regression was used to identify independent predictors of mortality.
Results
Mean patient age was 63.8 ± 11.5 years; 29% were women. STEMI accounted for 55% of cases (7,156 patients) and NSTEMI for 45% (5,943 patients). NSTEMI patients were older with more comorbidities (p<0.001). Coronary angiography was performed in 73% of patients. Primary PCI was conducted in 63% of STEMI and 48% of NSTEMI cases. Overall, in-hospital mortality was 9.0%, significantly higher in STEMI (12%) than NSTEMI (6%) (p<0.001). Mortality declined from 19.3% in 2014 to 7.7% in 2024. In multivariable analysis, independent predictors of in-hospital mortality included older age, female sex, current smoking, positive family history of cardiovascular disease, reduced left ventricular ejection fraction, and lack of primary PCI.
Conclusions
In-hospital AMI mortality in Kosovo declined substantially over 11 years, coinciding with the expansion of 24/7 primary PCI and more structured AMI care. ST-segment elevation myocardial infarction remained the predominant and highest-risk presentation. In multivariable analysis, older age, female sex, current smoking, positive family history of cardiovascular disease, reduced left ventricular ejection fraction, and lack of primary PCI were independently associated with higher in-hospital mortality. These findings highlight the importance of timely reperfusion and continued strengthening of acute cardiac care systems in countries with developing interventional cardiology services.