Key result
Statin persistence is linked to ~9-fold higher 1-year LDL-C target achievement post-AMI.
Why the study?
Secondary prevention after AMI is often evaluated by discharge prescribing, but first-year prognosis depends on whether pharmacological, rehabilitation, and lifestyle measures are maintained after discharge.
Observational (n=2,976)
No
Despite near-universal statin prescribing at discharge after acute myocardial infarction, less than one-third of patients achieve LDL-C targets at one year, primarily driven by post-discharge statin non-persistence and incomplete lifestyle pathway completion.
Statin persistence gaps may limit LDL-C target achievement post-AMI; leaves open optimal adherence strategies in prospective cohorts.
Background and Objectives: Secondary prevention after acute myocardial infarction (AMI) is often assessed by discharge prescribing, yet first-year prognosis depends on whether pharmacological, rehabilitation and lifestyle measures are completed after discharge. We evaluated one-year secondary prevention pathway completion after AMI and its relationship with LDL-C target achievement and exploratory outcomes. Materials and Methods: Consecutive STEMI/NSTEMI patients with documented follow-up were identified from the Cardiology Research Dubrava registry. We assessed discharge lipid-lowering therapy, statin persistence, LDL-C <1.4 mmol/L at 12 months, cardiac rehabilitation, exercise, dietary pattern, smoking status, left ventricular ejection fraction, angiographic complexity, biomarkers and one-year outcomes. Results: Among 2976 patients, statins were prescribed at discharge in 2782/2838 (98.0%), but LDL-C <1.4 mmol/L was achieved in 749/2566 (29.2%). Statin discontinuation or irregular use occurred in 915/2619 (34.9%) and was strongly associated with failure to reach target. Rehabilitation, exercise, favorable dietary pattern and smoke-free status were incompletely achieved and clustered with better LDL-C target attainment. One-year all-cause mortality was 288/2942 (9.8%), and ischemic MACE occurred in 395/2902 (13.6%). Events were associated with older age, reduced LVEF, greater angiographic complexity and higher inflammatory/neurohormonal burden. Conclusions: After AMI, the main first-year prevention gap was not discharge statin prescribing but post-discharge pathway completion. These findings support structured follow-up focused on statin persistence, LDL-C monitoring, treatment intensification, rehabilitation and lifestyle domains.
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Jurišić et al. (2026) conducted an observational in Acute myocardial infarction (n=2,976). Statin persistence vs. Statin discontinuation or irregular use was evaluated on LDL-C <1.4 mmol/L at 12 months. Despite a 98% discharge statin prescription rate, only 29.2% of post-AMI patients achieved LDL-C <1.4 mmol/L at 12 months, with target achievement strongly dependent on statin persistence (42.1% vs 4.7%).
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