Despite 98.0% discharge statin prescribing after AMI, only 29.2% achieved LDL-C <1.4 mmol/L at 1 year, largely driven by a 34.9% rate of statin discontinuation or irregular use.
Observational (n=2,976)
Despite high rates of statin prescription at discharge after AMI, long-term adherence and LDL-C target achievement remain poor, highlighting the need for structured post-discharge follow-up.
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.
Jurišić et al. (Sun,) conducted a observational in Acute myocardial infarction (AMI) (n=2,976). Secondary prevention pathway completion (statin persistence, rehabilitation, lifestyle) vs. Incomplete pathway completion / non-adherence was evaluated on LDL-C <1.4 mmol/L at 12 months. Despite 98.0% discharge statin prescribing after AMI, only 29.2% achieved LDL-C <1.4 mmol/L at 1 year, largely driven by a 34.9% rate of statin discontinuation or irregular use.