I have worked with two clients. Both north of 8 million visits a month. Both on matomo. Both self hosted.
If you architect the underlying infra right it still works like a charm. But I admit people need to know what they are doing. I was quite impressed with both infra teams.
But as always, if you do not want tu use auto scaling US cloud based services, you need to enasure you have the right scaling and the necessary technical expertise at hand.
I had no problems either, until we hit peaks. We hit our problems at about 7 million unique logins per month, we do not track visits in the same way. I am not that invested in Matomo and it just costs time for me.
I am not sure how you scale Matomo we could not vertically scale anymore, we never did MySQL clusters because it just was not cost efficient for internal reasons.