Informed and alternative consent pathways in time-critical acute myocardial infarction research: decision-making capacity, participant perspectives, and operational feasibility—a scoping review with systematic evidence mapping

Research enrolment in time-critical acute myocardial infarction (AMI) may occur while patients remain symptomatic and reperfusion is being arranged, constraining conventional prospective written consent. Evidence on research decision-making, participant involvement, alternative authorization procedures, workflow, and participant selection has not been systematically mapped in AMI. We therefore mapped AMI-specific empirical evidence on research consent and related enrolment procedures. We conducted a scoping review with systematic evidence mapping using a Population–Concept–Context framework and PRISMA-ScR where applicable. PubMed, Embase, CINAHL, Scopus, and Web of Science Core Collection were searched from inception through 2 August 2026; three broader validation searches using the same upper publication-date cutoff were conducted on 15 October 2026. Both the original and revision-stage searches were restricted to English-language records. Two reviewers independently screened records and full texts and independently coded pathway/context–domain contributions. Findings were synthesized across four empirical domains, with representativeness and selection treated as cross-cutting outcomes. Fifteen reports published between 1999 and 2023 met the eligibility criteria; the revision-stage validation searches identified no additional eligible report. Evidence concentrated on research decision-making and information processing and on patient or clinician perspectives on involvement. Studies assessed distinct constructs, including cognitive performance, comprehension, recall, perceived ability to decide, voluntariness, and preference for involvement. Oral, verbal-assent, and staged procedures were implemented in selected settings, but much of the remaining evidence concerned preferences, experiences, or hypothetical scenarios rather than direct pathway comparisons. Two observational studies reported longer reperfusion intervals associated with overall trial-enrolment processes, although neither isolated consent-specific time. Direct evidence on participant selection was limited, and no eligible report evaluated AMI-specific exception-from-informed-consent (EFIC) outcomes or directly compared regulatory practice across jurisdictions. The evidence identified does not provide a basis for identifying one research-consent pathway as preferable across all time-critical AMI trials. Consent-related constructs and evidence types should remain distinct. Comparative evidence on authorization procedures is limited, and observed workflow differences cannot be attributed specifically to consent. Future AMI trials should prespecify authorization pathways and prospectively assess understanding, involvement, workflow, and participant selection within the applicable ethical and regulatory framework. Open Science Framework, https://doi.org/10.17605/OSF.IO/UJMDP . Not applicable.