Аннотация
Background: Acute myocardial infarction (AMI) remains a major cause of mortality worldwide, with outcomes strongly influenced by healthcare system organization and timely access to reperfusion therapy. Evidence from Central Asia, including Kazakhstan, remains limited, particularly regarding real-world hospital-based outcomes. Objective: To assess clinical outcomes and temporal trends in the management of AMI in a tertiary cardiac center in Almaty, Kazakhstan. Methods: A retrospective observational cohort study was conducted at the City Cardiology Center in Almaty, including all adult patients with AMI admitted between 2023 and 2025. Data were obtained from hospital databases and institutional reports. Primary outcomes included in-hospital mortality, early (24-hour) mortality, and 30-day mortality. Secondary outcomes included procedural volumes and system performance indicators. Temporal trends were analyzed across study years. Results: In-hospital mortality remained stable (1.8% in 2023–2024 vs. 1.9% in 2025), as did AMI-specific mortality (6.0% in 2024 vs. 6.1% in 2025). However, significant improvements were observed in short-term outcomes. Early mortality decreased from 69 to 60 cases (–13.0%), while 30-day mortality declined from 176 to 163 cases (–7.4%). Post-discharge mortality also decreased from 57 to 48 cases (–15.8%). Procedural volumes showed mixed trends: PCI and stenting volumes decreased, while coronary angiography volumes remained stable or slightly increased. At the same time, system performance indicators improved substantially: the proportion of patients seeking care within 60 minutes increased from 55.2% to 89.0%, and the proportion of patients undergoing PCI within 60 minutes of arrival increased from 57.2% to 70.4%. Conclusion: Improvements in healthcare system performance, particularly reduced treatment delays and optimized care pathways, were associated with better short-term outcomes in AMI patients. These findings highlight the importance of system-level interventions and provide valuable evidence for strengthening cardiovascular care in Kazakhstan and other Central Asian countries.