CARDIOVASCULAR MEDICINE

¹ Groupe Hospitalier Bichat – Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France
² Cardiovascular Research, Department of Medical and Radiological Sciences, University of Edinburgh, Edinburgh, UK
³ Cardiology Department, Onassis Cardiac Surgery Centre, Athens, Greece
⁴ Cardialysis BV, Rotterdam, Netherlands
⁵ Institut für Epidemiologie und Sozialmedizin, Universität Münster, D48149 Münster, Germany
⁶ Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche, Milan, Italy

Correspondence to:
Correspondence to:
Dr Philippe Gabriel Steg, Cardiology, Hôpital Bichat, 46 rue Henri Huchard, 75877 Paris Cedex 18, France;
gabriel.steg{at}bch.ap-hop-paris.fr

Background: It has been suggested that patients undergoing acute intervention for coronary syndromes may not receive adequate secondary prevention.

Objective: To analyse the impact of availability and use of coronary interventions on the prescription of secondary prevention after acute coronary syndromes.

Design: Analysis of a prospective multicentre register of patients admitted to hospital for acute coronary syndromes.

Setting: A 1999 pan-European survey in 390 hospitals.

Patients: 3092 patients admitted to hospital with acute coronary syndromes (including 777 for ST elevation myocardial infarction within 12 hours of onset).

Main outcome measures: Rates of prescription of aspirin and lipid lowering agents.

Results: Performance of coronary angiography and percutaneous coronary interventions (PCI) during the hospital stay were independent predictors of prescription of aspirin at discharge (odds ratio (OR) 1.29 and 1.89, p = 0.053 and p < 0.0001, respectively). Lipid lowering agents were prescribed more often on discharge in patients admitted to hospitals with catheterisation laboratories than without (for infarction with ST elevation, 45% v 40% (NS); for other acute coronary syndromes, 46% v 36%; p < 0.05). Prescription rates were higher among patients undergoing coronary angiography or PCI than in those treated conservatively (for infarction with ST elevation, 49%, 53%, and 39%, p < 0.05; for other acute coronary syndromes, 50%, 54%, and 34%, p < 0.05). Logistic regression analysis showed that PCI was an independent predictor of prescription of lipid lowering agents at discharge (OR 1.48, p < 0.0002).

Conclusions: Contrary to expectations, invasive procedures for acute coronary syndromes are associated with higher rates of prescription of pharmacological secondary prevention.

Keywords: acute coronary syndromes; aspirin; lipid lowering treatment; myocardial infarction

Abbreviations: ACE, angiotensin converting enzyme; ENACT, European network for acute coronary treatment; HOPE, heart outcomes prevention trial; PCI, percutaneous coronary intervention

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