EPIDEMIOLOGY AND MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION IN PAKISTAN: A MULTI-DIMENSIONAL ANALYSIS

Abstract

Acute myocardial infarction (AMI) remains a significant cause of morbidity and mortality in Pakistan, exacerbated by delayed presentation, inadequate risk factor control, and inconsistent management protocols. This multi-center, prospective cohort study evaluated the epidemiological patterns and management outcomes of AMI across tertiary care hospitals in Lahore, Karachi, and Peshawar from January 2023 to December 2024. A total of 1,200 patients diagnosed with AMI were enrolled and stratified into two groups: Group A received standard care, while Group B was managed using a standardized clinical pathway incorporating early invasive strategies. The primary outcomes assessed were changes in left ventricular ejection fraction (LVEF) and in-hospital mortality. Secondary outcomes included rehospitalization rates and major adverse cardiovascular events (MACE) over a six-month follow-up period. Group B demonstrated a significant improvement in LVEF (mean increase of 13.1% ± 2.3) compared to Group A (mean increase of 7.5% ± 1.8; p < 0.001). In-hospital mortality was notably lower in Group B (3%) versus Group A (9%; p = 0.01). Rehospitalization for heart failure and incidence of MACE were also significantly reduced in Group B (p = 0.02 and p = 0.01, respectively). These findings underscore the efficacy of standardized clinical pathways and early invasive strategies in improving AMI outcomes in resource-limited settings. This study provides novel insights into the implementation of structured AMI management protocols in Pakistan, highlighting the need for nationwide adoption to enhance patient outcomes.(pakheartjournal1.pcs.org.pk, pubmed.ncbi.nlm.nih.gov)