Clinical outcomes with high-intensity statins according to atherothrombotic risk stratification after acute myocardial infarction: The FAST-MI registries

Aims. - To analyse the relationship between prescription of high-intensity statin therapy atdischarge and long-term clinical outcomes according to risk level defined by the ThrombolysisIn Myocardial Infarction Risk Score for Secondary Prevention (TRS-2P) after acute myocardialinfarction. Methods. - We used data from the FAST-MI 2005 and 2010 registries - two nationwide Frenchsurveys including 7839 consecutive patients with acute myocardial infarction. Level of risk wasstratified in three groups using the TRS-2P score: Group 1 (low risk; TRS-2P = 0-1); Group 2( intermediate risk; TRS-2P = 2); and Group 3 (high risk; TRS-2P >= 3). Results. - Among the 7348 patients discharged alive with a TRS-2P available, high-intensitystatin therapy was used in 41.3% in Group 1, 31.3% in Group 2 and 18.5% in Group 3. Aftermultivariable adjustment, high-intensity statin therapy was associated with a non-significantdecrease in major adverse cardiovascular events (death, stroke or recurrent myocardial infarction) at 5 years in the overall population compared with that in patients receiving intermediateor low-intensity statins or without a statin prescription (14.3% vs 29.6%; hazard ratio 0.94, 95% confidence interval 0.81-1.09; P = 0.42). In absolute terms, the decrease in major adverse cardiovascular events was positively correlated with risk level (Group 1: 8.1% vs 10.7%; Group 2: 14.8% vs 21.6%; Group 3: 30.8% vs 51.6%). However, after adjustment, the benefits of highintensity statin therapy were associated with lower mortality only in high-risk patients (hazardratio 0.79, 95% confidence interval 0.64-0.97; P = 0.02). Conclusions. - High-intensity statin therapy at discharge after acute myocardial infarction wasassociated in absolute terms with fewer major adverse cardiovascular events at 5 years, regardless of atherothrombotic risk stratification, although the highest absolute reduction was foundin the high-risk TRS-2P class. (C) 2020 Elsevier Masson SAS. All rights reserved.