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The following is a summary of “Impact of statin adherence and interruption within 6 months after ST-segment elevation myocardial infarction (STEMI): Results from the real-world regional registry FAST-STEMI,” published in the June 2024 issue of Cardiology by Giacobbe et al.

It is unclear how statin therapy (ST) affects cardiovascular (CV) outcomes after ST-elevation acute myocardial infarction (STEMI) in patients.

Researchers conducted a retrospective study identifying factors for discontinuation of statin therapy within 6 months after a STEMI and estimated how this influenced CV health a year later. 

They assessed how well patients stuck to statin therapy by comparing purchased tablets to expected ones after 1-year using pharmacy records. From 2012 to 2017, 6,043 patients with STEMI were in the FAST STEMI registry, tracking them for about 4.7 years, excluding 304 patients who died during procedures or in the hospital. The primary outcome was to understand all-cause death, CV death, myocardial infarction, major and minor bleeding events, and ischemic stroke. 

The results showed that of 5,744 patients, 418 (7.2%) stopped statins within 6 months post-STEMI, while 3,337 (58.1%) adhered> 80%. Statin optimal adherence was protective for CV (0.1% vs. 4.6%; AdjHR 0.025 [0.008-0.079], P<0.001) and all-cause mortality (0.3% vs. 13.4%, aHR 0.032 [0.018-0.059], P<0.001) at 1 year with reduced ischemic strokes (1% vs. 2.5%, P=0.001). Stopping statins increased CV (5% vs. 1.7%; aHR 2.23, [1.73-2.65], P=0.001) and all-cause mortality (14.8% vs. 5.1%, aHR 2.32, [1.73-3.11], P<0.001). Predictors of therapy discontinuations: age>75, ischemic cardiopathy, female gender. Predictors of low adherence: age>75, chronic kidney disease, atrial fibrillation, vasculopathy, ischemic cardiopathy. 

Investigators concluded that low statin adherence and stopping therapy within 6 months after STEMI were linked to higher CV and all-cause mortality at 1 year, plus increased ischemic stroke rates.

Source: sciencedirect.com/science/article/abs/pii/S0167527324004510