Actual use of statins at hospital discharge after acute myocardial infarction

We investigated the use of statins in clinical practice in patients with ac ute myocardial infarction in Germany in 17732 consecutively included patien ts of the registries MIR-1 and MITRA-1. A clinical follow-up has been perfo rmed in the MITRA-1 study after a mean period of 18 months. In total 30% of all patients with acute myocardial infarction received statins at discharg e. From 1994 to 1998 the use of statins increased from 6% to 44%; however i n 1998 still less than half of the patients with acute myocardial infarctio n received statins at discharge. In a logistic regression model, concomitta nt diseases as renal failure (OR 0.7), heart failure (OR 0.7) and diabetes mellitus (OR 0.9) were associated with a lower use of statins. Age > 70 yea rs (OR 0.5) was also associated with a lower use of statins at hospital dis charge. Patients with statins at discharge had a lower long-term mortality of 5.8% versus 12.9% in patients without statins. After adjustment to age a nd comorbidity, use of statins at discharge was associated with a borderlin e significant reduction of long-term mortality (multivariate OR 0.7, 95% CI 0.4-1.0). In a subgroup analysis of therapeutic benefit, measured by the " number needed to treat" (NNT), the number of patients to treat with statins to save one life, patients with cardiovascular risk factors, as heart fail ure (NNT 7.5), diabetes mellitus (NNT 7.8) and age > 70 years (NNT 13.8) ha d a larger therapeutic benefit as patients without these risk factors (NNT 345). However, these high-risk patients received less often statins than pa tients without risk factors (use of statins 11.8% versus 19.8%).