Full secondary prevention medication regimen is often under prescribed after AMI.

We aimed to analyze rates of appropriate medical treatment at discharge after AMI across risk categories defined by the TIMI Risk Score for Secondary Prevention (TRS-2P), in a routine-practice population and to determine the efficacy of appropriate therapy on one-year mortality according to risk level.

We used data from the 2005, 2010 and 2015 FAST-MI registries, including 12,290 consecutive AMI patients admitted to cardiac intensive care units and discharged alive. Level of risk was stratified in 3 groups using the TRS-2P score calculated at discharge: G1 (Low-risk; TRS-2P=0 or 1); G2 (Intermediate-risk; TRS-2P=2); and, G3 (High-risk; TRS-2P≥3). Appropriate secondary prevention treatment was defined according to the latest ESC guidelines (dual antiplatelet therapy and statins for all, and ACEi/ARB and beta-blockers as indicated).

Prevalence of G1, G2, and G3 was 43%, 25% and 32% respectively. Appropriate secondary prevention treatment was used in 76%, 62% and 46%, respectively. After multivariate adjustment, appropriate therapy at discharge was associated with improved survival in all risk categories: 0.60 (0.38–0.97, P=0.03) in G1, 0.61 (0.40–0.91, P=0.02) in G2, and 0.67 (0.55–0.82, P<0.001) in G3. Lack of appropriate treatment at discharge resulted in an increased absolute risk of death which was considerably higher in the high-risk group (Table 1).

Use of appropriate medical treatment at discharge is inversely correlated with patient risk. It is associated with similar relative risk reductions in one-year death across risk categories, but in absolute terms, the increased hazard related to lack of prescription of recommended medications is much greater in high-risk patients. Specific efforts should be directed at better prescription of recommended treatment, particularly in high-risk patients.