Comparative Outcomes of primary PCI and one-year MACE in Iranian and Afghan Patients with STEMI: A propensity score-matched retrospective cohort at Tehran Heart Center.

Background: Although advances in primary percutaneous coronary intervention (PPCI) have significantly reduced mortality and procedure-related complications, substantial disparities persist among vulnerable populations. Afghan immigrants in Iran face intersecting socioeconomic and structural barriers that may compromise long-term cardiovascular outcomes. Addressing these inequities is crucial to improving outcomes in vulnerable populations. Objective: To evaluate the success of PPCI and the one-year incidence of major adverse cardiovascular events (MACE) among Iranian and Afghan patients with ST-segment elevation myocardial infarction (STEMI) treated at Tehran Heart Center. Methods: This retrospective cohort study included STEMI patients who underwent PCI at Tehran Heart Center between March 2015 and March 2024. Eligible patients were categorized by nationality. Demographic data, medical history, laboratory results, and angiographic/procedural details were retrieved from the angioplasty registry. A one-year follow-up was conducted via outpatient visits and structured telephone interviews. Results: A total of 6,883 STEMI patients were analyzed (6,776 Iranian; 107 Afghan). Iranian patients were older, had higher body mass index, and more cardiovascular risk factors. Angiographic findings showed greater left main and left anterior descending artery involvement in Afghan patients, while right coronary artery involvement was more common in Iranians. After applying propensity score matching, no significant differences were found in PCI failure rates (OR: 1.54; 95% CI: 0.41-10.0; p = 0.573) or 12-month MACE (HR: 0.94; 95% CI: 0.42-2.09; p = 0.884) between the two groups. Conclusion: There were no significant differences in PPCI success or one-year MACE outcomes between Iranian and Afghan STEMI patients treated at our Center.