Achievement of secondary prevention targets after STEMI: results from the IMPACS Study
R Molnar, E Teringova, I Soosova, I Rybar, M Gbur, J Kmec, M Luknar, M Studencan, E GoncalvesovaAbstract
Background
Effective secondary prevention is essential to reduce morbidity and mortality after acute coronary syndrome. However, adherence to comprehensive secondary-prevention strategies remains suboptimal, despite strong guideline recommendations.
Aim
To evaluate one-year cardiovascular risk-factor control and guideline-directed medical therapy within a structured intensive secondary-prevention program after ST-segment elevation myocardial infarction (STEMI).
Methods
Consecutive STEMI patients were enrolled in the intervention group at four PCI centres in Slovakia. Participants attended four structured outpatient visits within the first year after discharge, focusing on clinical assessment, pharmacotherapy optimization, and comprehensive risk-factor management. The present analysis reports prespecified secondary objectives related to cardiovascular risk-factor control and pharmacotherapy during one-year follow-up in the intervention cohort. Analyses comparing clinical outcomes with standard care are ongoing and will be reported separately.
Results
Among 1,031 STEMI patients, significant improvements in risk-factor control were observed. Mean LDL-cholesterol decreased from 3.5 ± 1.1 mmol/L at index hospitalization to 1.8 ± 1.0 mmol/L at one year (p < 0.001), with 67% of patients achieving <1.8 mmol/L and 39% reaching the recommended target of <1.4 mmol/L. Systolic and diastolic blood pressures declined significantly over study period (p = 0.047 and p < 0.001, respectively), with 77% of patients attaining systolic BP <140 mmHg and 51% reaching <130 mmHg. Active smoking decreased from 49% at baseline to 13% at one year (p < 0.001), and fasting plasma glucose levels improved significantly over the follow-up period (p = 0.013). BMI remained unchanged (p = 0.43). Use of recommended medications demonstrated high adherence to guideline-directed therapy. Dual antiplatelet therapy (DAPT) was prescribed in 95% of patients at discharge and remained above 89% during follow-up. Statins were prescribed in 99% of patients at discharge and continued in 96% throughout the study. Combined hypolipidemic therapy with ezetimibe was used in 75% of patients, and PCSK9-targeted therapies in 16%. Beta-blockers use increased from 87% at discharge to 91% at one year. Angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs) were used in 76% at discharge and 79% at one year.
Conclusion
Structured secondary prevention program delivered during the first year after STEMI was associated with significant improvements in lipid levels, blood pressure, fasting plasma glucose, and smoking cessation, as well as high utilisation of guideline-recommended medical therapy. Further outcome analyses will determine whether this novel approach translates into improved clinical outcomes.