Management and clinical outcome of myocardial infarction in Kosovo: A cross-sectional study

Background and Aims: Myocardial infarction (MI) is a major cause of mortality worldwide, irrespective of its presentation as non-ST-segment elevation MI (NSTEMI) or ST-segment elevation MI (STEMI). The objective of this study was to assess national results of management and clinical outcome of acute MI patients in Kosovo. Methods: This cross-sectional descriptive study, conducted at the Clinic of Cardiology of the University Clinical Center of Kosovo, in Prishtina, included all patients hospitalized with acute MI over a period of 7 years (2014-2020). The primary outcome of the study was in-hospital mortality. Results: Among 7353 admitted patients with acute MI (mean age 63 +/- 12 years, 29% female) and according to the final diagnosis, 4436 (59.4%) patients had STEMI, and 2987 (40.6%) NSTEMI. More patients with STEMI received primary percutaneous intervention (PPCI) than those with NSTEMI (50% vs. 41%, p < 0.001). In-hospital mortality was higher in no PPCI patients compared to PPCI both in NSTEMI (10.7% vs. 2.6%, p < 0.001) and STEMI (20.9% vs. 6.8%, p < 0.001). Age >= 65 years [0.399 (0.267-0.597), p < 0.001], hemoglobin level [0.889 (0.815-0.970), p = 0.008], STEMI [0.491 (0.343-0.704), p < 0.001], lack of PPCI [2.636 (1.798-3.866), p < 0.001], cardiogenic shock [0.002 (0.001-0.006), p < 0.001], reduced left ventricular ejection fraction (LV EF) [0.966 (0.951-0.980), p < 0.001], and heart rate at admission [1.009 (1.000-1.017), p = 0.047], independently predicted mortality. In STEMI, cardiogenic shock (p < 0.001), lack of PPCI (p = 0.006), female gender (p = 0.01), and low LV EF (p = 0.04) predicted mortality but age >= 65 years (p = 0.02), female gender (p = 0.02), low LV EF (p = 0.007), and low hemoglobin (p = 0.04) predicted mortality in NSTEMI. Conclusion: Between 2014 and 2020, half of patients with acute MI were not treated with PPCI, who had high mortality, particularly when presenting with STEMI. Age, cardiogenic shock, anemia, low LV EF, STEMI and no PPCI independently predicted mortality. Cardiogenic shock and lack of PPCI independently predicted mortality, only in STEMI.