Door-to-Balloon Time vs. Total Ischemic Time as Predictors of Mortality in ST-Segment Elevation Myocardial Infarction (STEMI) Patients

Background Cardiovascular diseases remain a major cause of morbidity and mortality in Pakistan. Early identification of high-risk individuals is essential for improving outcomes. Objective To evaluate clinical characteristics, risk factors, and outcomes among patients presenting with cardiovascular conditions at two major tertiary care centers in Pakistan. Materials and methods This prospective observational two-center study in Pakistan was conducted at Mardan Medical Complex (Mardan) and Peshawar General Hospital (Peshawar) from January 2022 to December 2023. A total of 2,530 patients were enrolled (mean age 58.42 ± 11.36 years), including 1,964 males (77.66%) and 566 females (22.34%). Demographic data, comorbidities, clinical presentation, laboratory parameters, management strategies, and outcomes were collected and analyzed. Results Hypertension, diabetes mellitus, and smoking were the most prevalent comorbidities. Most patients presented with acute coronary syndromes, with ST-elevation myocardial infarction being the predominant subtype. Early revascularization, including primary percutaneous coronary intervention (PCI), was performed when indicated. Mortality and complication trends were comparable across both centers. Advanced age and multiple cardiovascular risk factors were significantly associated with adverse outcomes. Conclusion This prospective two-center study provides meaningful insight into the cardiovascular disease burden in Pakistan. The findings highlight the need for improved preventive strategies, timely diagnosis, and better risk-factor management to reduce cardiovascular morbidity and mortality.