# Epidemiological 11-Year Dynamics Study of Acute Myocardial Infarction: A Cohort Study in a Country with a Transitional Healthcare System

## TL;DR

This study tracks 11 years of heart attack trends in Kosovo, showing rising incidence followed by a decline, with risk factors like smoking and hypertension, and improved survival rates likely due to better treatments.

## Contribution

The study provides a detailed epidemiological analysis of AMI in a transitional healthcare system, identifying risk clusters and temporal trends.

## Key findings

- AMI incidence increased from 23.5 to 86.4 per 100,000 between 2014–2021, then decreased to 71.3 in 2024.
- STEMI patients were younger and more often male and smokers, while NSTEMI patients were older with higher rates of diabetes and hypertension.
- In-hospital mortality dropped from 19.3% in 2014 to 7–10% in 2022, likely due to increased use of reperfusion procedures.

## Abstract

Acute myocardial infarction (AMI) remains a major global health problem, being the leading cause of both morbidity and mortality. We aim to present the temporal trends, demographic, clinical characteristics and risk factors of AMI in Kosovo.

We conducted a retrospective, single-center observational study at the Clinic of Cardiology, University Clinical Center of Kosovo, having analyzed all patients admitted with AMI between January 2014 and December 2024. STEMI and NSTEMI cases were diagnosed according to ESC criteria. Patient’s risk factors, biomarkers, PCI, and outcome data were extracted from hospital clinical records. Latent class analysis identified patient subgroups based on risk profiles. Temporal trends and projections of AMI incidence (per 100,000 population) were analyzed using polynomial and Joinpoint regression models. Statistical comparisons employed Chi-squared, t-tests, or Mann-Whitney U tests.

Over the course of 11 years, 13,099 AMI patients (mean age 63.8 years; 29% female) were admitted; 55% had STEMI and 45% NSTEMI. Annual Age-standardized incidence increased from 23.5 to 86.4 per 100,000 (2014–2021) then fell to 71.3 in 2024. Hypertension (66%), smoking (47%), diabetes (34%) and dyslipidemia were highly prevalent. Latent class analysis identified four distinct patient clusters with varying combinations of smoking, diabetes, hypertension and family history of cardiovascular disease (CVD) (p < 0.001). STEMI patients were younger, more often male and smokers, while NSTEMI patients were older with higher rates of diabetes, hypertension and prior LBBB. In-hospital mortality was 9.15%, higher for STEMI (~12%) than NSTEMI (~6%), and declined markedly over time (19.3% in 2014 vs 7–10% in 2022, p < 0.001).

In a developing country, Kosovo, STEMI was more frequent than NSTEMI, affecting younger male patients. The leading risk factors included arterial hypertension, smoking, diabetes mellitus, and a family history of CVD. The decline in acute MI related mortality over recent years, can be explained by the increasing use of myocardial reperfusion procedures. Furthermore, the rates of acute MI related complications are not different from neighboring countries.