One-Year Gaps in Comprehensive Secondary Prevention After Acute Myocardial Infarction: Statin Persistence, LDL-C Target Achievement, Rehabilitation, and Lifestyle Adherence.

Background and Objectives: Secondary prevention after acute myocardial infarction (AMI) is often assessed by discharge prescribing, yet first-year prognosis depends on whether pharmacological, rehabilitation and lifestyle measures are completed after discharge. We evaluated one-year secondary prevention pathway completion after AMI and its relationship with LDL-C target achievement and exploratory outcomes. Materials and Methods: Consecutive STEMI/NSTEMI patients with documented follow-up were identified from the Cardiology Research Dubrava registry. We assessed discharge lipid-lowering therapy, statin persistence, LDL-C <1.4 mmol/L at 12 months, cardiac rehabilitation, exercise, dietary pattern, smoking status, left ventricular ejection fraction, angiographic complexity, biomarkers and one-year outcomes. Results: Among 2976 patients, statins were prescribed at discharge in 2782/2838 (98.0%), but LDL-C <1.4 mmol/L was achieved in 749/2566 (29.2%). Statin discontinuation or irregular use occurred in 915/2619 (34.9%) and was strongly associated with failure to reach target. Rehabilitation, exercise, favorable dietary pattern and smoke-free status were incompletely achieved and clustered with better LDL-C target attainment. One-year all-cause mortality was 288/2942 (9.8%), and ischemic MACE occurred in 395/2902 (13.6%). Events were associated with older age, reduced LVEF, greater angiographic complexity and higher inflammatory/neurohormonal burden. Conclusions: After AMI, the main first-year prevention gap was not discharge statin prescribing but post-discharge pathway completion. These findings support structured follow-up focused on statin persistence, LDL-C monitoring, treatment intensification, rehabilitation and lifestyle domains.