ArticleInternational journal of cardiology. Cardiovascular risk and prevention2026
Five-year implementation and longitudinal performance of a multidisciplinary acute myocardial infarction program in a middle-income country.
Article in International journal of cardiology. Cardiovascular risk and prevention, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Acute myocardial infarction (AMI) remains a leading cause of mortality in low- and middle-income countries, where delayed reperfusion worsens outcomes. Evidence on the long-term operation of multidisciplinary AMI programs in these settings is limited. We aimed to describe the five-year performance of a multidisciplinary AMI program in quality-of-care indicators and clinical outcomes. Methods: Prospective cohort of adults with type 1 AMI treated between 2021 and 2025 in an internationally multidisciplinary AMI Center of Excellence, integrating standardized reperfusion pathways, multidisciplinary inpatient care, cardiac rehabilitation, and structured post-discharge follow-up. Indicators were compared across years; multivariable logistic regression identified factors associated with in-hospital mortality. Results: Of 3581 patients, 131 (3.7%) died in hospital. Non-survivors more often had STEMI (54.2% vs 42.2%; P = 0.007), Killip class III-IV (52.2% vs 7.9%), and higher TIMI and GRACE scores (all P < 0.001). Killip class was independently associated with mortality, rising stepwise from class II (aOR 3.81; 95%CI 2.00-7.25) to class IV (aOR 35.81; 95%CI 19.54-65.65); AUC 0.789. Compared with 2021, adjusted odds of in-hospital mortality were lower in 2025 (aOR 0.34; 95%CI 0.14-0.84; P = 0.019). Nursing education adherence (92.0% to 98.9%) and timely phase I cardiac rehabilitation (74.6% to 96.7%) were higher in later years, and ECG acquisition time was shorter (all P < 0.001). Unadjusted in-hospital mortality did not differ significantly across years (P = 0.287), and door-to-balloon time remained stable (P = 0.118). Conclusion: The program sustained high adherence to quality indicators and stable reperfusion metrics, whereas post-discharge follow-up completion declined. These findings do not establish causal effects.
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