Five-year implementation and longitudinal performance of a multidisciplinary acute myocardial infarction program in a middle-income country

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.