Secondary prevention following coronary intervention. Survey of 13 interventional centres in Austria

Risk factor control has been shown to reduce the incidence of coronary even ts in patients with or without preceding infarction. Secondary prevention s hould therefore be borne in mind by every cardiologist. In order to test th is concept and / or to promote secondary prevention in our country, the fol lowing survey was conducted by our working group for epidemiology and preve ntion. All interventional centres of the country (7 million inhabitants) we re asked to report relevant data of 50 consecutive patients with PTCA in a structured questionnaire. Thirteen centres responded and we report the data of 650 patients. The mean proportion of women was 28%, the mean age 61.1 y ears and the mean stent rate 49.8%. The indications for PTCA varied widely: stable angina 10-74%, unstable angina 10-86%, primary PTCA 0-22%. The risk factor history was distributed as follows: diabetes 12-46% (mean 22.3%), h ypertension 32-68% (mean 54.2%), current smoking 6-56% (mean 21.9%), and to tal cholesterol (TChol) >200 mg/dl : 30-78% (mean 60.3%). Current lipid val ues were available for T chol. in 44-100% (mean 84.5%) and for LDL in 4-100 % (mean 67.1%). Dietary counselling by a dietician was done in 4-100% of pa tients (mean 35.6%) Information concerning the hazards of smoking was given to 25-100% (mean 83.6%) of current smokers. Drug treatment at hospital dis charge was as follows: 84-100% (mean 93.1%) received ASA, 24-74% (mean 49.8 %) ticlopidine, 6-84% (mean 53.3%) nitrates, 34-82% (mean 60. 2%) beta bloc kers, 10-70% (mean 39.5%) ACE inhibitors, 4-74% (mean 4 7.2%) lipid lowerin g drugs, 7-48% (mean 17.8%) calcium antagonists, 0-12% (mean 6.1%) digitali s and 0-28% (mean 13.6%) diuretics. Follow-up data were collected in 4 centres at 6 months post discharge and w ere available for 174 patients. Here we found an increase in the prescripti on of calcium antagonists, digitalis and statins. The following conclusions were drawn at a conference in which all centres p articipated : lipid values should be available for each patient at PTCA, di etary counselling should be initiated for every patient during hospitalisat ion land continued by the family physician) and the national cardiac societ y should promote guidelines for the use of drugs in which the variation in use is too wide at present. It should be ensured that these guidelines are implemented not only in patients after AMI but also in those after PTCA.