ARMI registry: first nationwide prospective evaluation of STEMI outcomes in Armenia

Background Coronary artery disease is the leading cause of mortality in Armenia. To address the lack of national real-world data on reperfusion practices and outcomes, the Armenian National Registry of Myocardial Infarction (ARMI) was established in December 2023 as the first nationwide prospective STEMI registry. Objectives The primary endpoint of the study was to determine in-hospital mortality rates in patients admitted with STEMI across all participating national centers. The secondary endpoints included assessing 30-day and 12-month cardiovascular mortality, all-cause mortality, and rehospitalization rates. Methods ARMI prospectively enrolled consecutive adults aged 18-93 years presenting with STEMI within 48 hours of symptom onset across 13 specialized hospitals nationwide. Trained investigators collected standardized clinical, procedural, and outcome data using a secure national REDCap electronic database. All patients were followed prospectively for 12 months, with structured assessments at 30 days and 12 months. Enrollment ran from 1 December 2023 to 1 July 2025. Results A total of 2,222 patients were enrolled across all 13 centers. The present analysis includes 1,392 patients with complete follow-up data. The cohort was predominantly male (81.1%; n=1,129), with 18.9% women (n=263). Percutaneous coronary intervention (PCI) was performed in 96.8% of patients (n=2,098), of whom 99.6% underwent primary PCI (n=2,090). Medical therapy alone was used in 2.7% (n=58), and 0.6% (n=12) required coronary artery bypass grafting. In-hospital reinfarction and recurrent ischemia occurred in 3.4% and 4.2% of patients, respectively. Overall in-hospital mortality was 3.1%. Cardiovascular causes accounted for 91.0% of all in-hospital deaths. Reduced systolic function was a major contributor, with 62.5% of deceased patients having LVEF ≤40%. Acute HF with Killip class 3-4 at presentation was identified in 8.0% of patients. In-hospital mortality in patients with Killip class 3-4 was substantially higher at 9.0% versus 3.1% for the overall cohort. At one year, all-cause mortality was 8% in the overall population and 32% in patients presenting with Killip class 3-4, confirming the powerful adverse prognostic impact of early HF severity. HF-related rehospitalization occurred in 13% of Killip class 3-4 patients versus 36% in the overall cohort, reflecting ongoing morbidity burden. Conclusions ARMI establishes the first national benchmark for STEMI care in Armenia, demonstrating near-universal primary PCI use and low in-hospital mortality (3.1%), comparable to that reported in European registries. Acute HF at presentation identified a high-risk subgroup with markedly higher in-hospital and 1-year mortality. Left ventricular ejection fraction ≤40% emerged as a key prognostic marker. The ARMI registry provides a foundation for future translational research and nationwide quality improvement initiatives.