Lipid-lowering therapy of patients surviving myocardial infarction in Hungary – the data of the National Myocardial Infarction Registry
Márk László1, Jánosi András2, Ferenci Tamás3, Andréka Péter2
1Békés Megyei Központi Kórház, Pándy Kálmán Tagkórház, Kardiológia Osztály, Gyula
2Gottsegen György Országos Kardiológiai Intézet, Nemzeti Szívinfarktus Regiszter, Budapest
3Óbudai Egyetem, Élettani Szabályozások Kutató Központ, Budapest
The administration of statins in the treatment of acute coronary syndrome according to the Hungarian and international guidelines has a priority, after the event independently of current lipid levels and later on attaining the goals. When analyzing the data of National Myocardial Infarction Registry, it has observed for several years that a part of patients does not receive recommendation for statin therapy at the time of hospital discharge. The goal of the present evaluation was to study the change in the statin recommendation during years, the difference in this field among health care providers and the factors influencing the recommendation for the further treatment at hospital discharge. We analyzed the data of 29,144 patients registered between 1 January 2014 and 31 December 2018. 62.9% were males, 12,029 (41.3%) suffered from ST-elevation myocardial infarction, 17,115 (58.7%) had a non-ST elevation myocardial infarction. The rate of patients receiving statin recommendation at the discharge was evaluated for all studied parameters as a univariable analysis. For multivariable analyses, multiple regression model was used. During the years, there was no significant change in the rate of statin recommendation (P=0.3317). There was a significantly higher frequency of statin recommendation in males (95.4% vs. 92.9%). In the multivariate analysis, the hazard ratio of female sex proved to be 0.85 (95% CI: 0.75–0.96 P=0.0096). The occurrence of statin recommendation was significantly less frequent in younger (below 40) and older patients (over 70 years) (P<0.001). Its frequency was 96.4% in patients with ST-segment elevation myocardial infarctions and 93.1% in those with non-ST-segment elevation; in the multivariate model the hazard ratio for ST-segment elevation myocardial infarction was 1.21 (95% CI: 1.05–1.39 P=0.0088). After percutaneous coronary intervention, the occurrence of statin recommendation was significantly more frequent (97.1% vs. 86.8%). In cases with no intervention, the hazard ratio for recommendation was 0.35 (95% CI: 0.31–0.41; P<0.001). The occurrence of myocardial infarction, stroke, percutaneous intervention, hypertension and diabetes in the medical history had no significant effect on statin recommendation, although that of hypercholesterolemia had (96.6% vs. 93.0%), the hazard ratio for hypercholesterolemia in multivariate model was 1.67 (95% CI: 1.44–1.94, P<0.001). There was similar the frequency of statin recommendation among the invasive centers (93.9-99.0%), but a significant difference was observed in the group of hospitals (37.0-96.3%). Effort has to be put for the administration of life expectancy improving high dose statin treatment in patients discharged with acute coronary syndrome. Greater attention is needed in women, in non-ST elevation infarctions, in younger and older patients and in cases discharged without coronary invasive intervention.