Patterns of statin prescription in acute myocardial infarction: the French registry of Acute ST-elevation or non-ST-elevation Myocardial Infarction (FAST-MI).

OBJECTIVE

Early use of high-dose statins in acute coronary artery disease is controversial. Our aim was to use the French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) to analyse patterns of statin prescription during the acute phase of myocardial infarction, and to identify factors associated with prescription strategies.

METHODS

We analysed statin prescription in 2509 patients with an acute myocardial infarction enrolled at 223 hospitals in France who were enrolled in the FAST-MI study and survived to hospital discharge. Patients were subdivided into four groups: never prescribed statins (n=304); only prescribed statins at hospital discharge (n=293); prescribed statins in the first 48 h of hospitalization and at discharge (n=1318); prescribed statins before hospitalization, in the first 48 h of hospitalization and at discharge (n=594).

RESULTS

Multivariable analysis showed that the presence of notable coronary lesions was significantly associated with all three statin prescription categories (P<0.001). History of hypercholesterolaemia (P<0.001) and prescription of evidence-based therapies for myocardial infarction in the first 48 h of hospitalization (P<or=0.05) were significantly associated with statin prescription in the first 48 h and at discharge, and with continuation of statin prescription if patients were receiving statins before hospitalization. High doses of statins were prescribed rarely; only 20.2% of patients prescribed statins in the first 48 h of hospitalization and at discharge received atorvastatin 80 mg/day.

CONCLUSIONS

Use of statins by French cardiologists in the management of acute myocardial infarction is high, though still suboptimal. Outcomes may be improved by encouraging adherence to current guidelines, promoting the findings of clinical trials illustrating the benefits of intensive statin therapy, and reassessing professional practices in this setting.