[Long-term management of coronary patients: current guidelines and practices]

The management of coronary patients aims at improving the prognosis, by preventing myocardial infarction and/or death, and also at optimal reduction of symptoms related to coronary disease. This can be achieved by a variety of approaches including coronary revascularisation, life-style modifications and drug therapies including several drug classes: platelet inhibitors, beta-blockers, angiotensin converting enzyme (ACE) inhibitors, statins and anti-anginal drugs. The B.A.S.I.C. regimen is a combination of a beta-blocker, a platelet inhibitor, a statin and an ACE inhibitor for secondary prevention in coronary patients. Although recommended in the latest ESC and AHA/ACC guidelines, this strategy is insufficiently applied in medical practice. Indeed, the results of the European Action on Secondary Prevention by Intervention to Reduce Events (EUROASPIRE) Survey conducted over the period 1999-2000, show that 6 months after a first hospitalisation for aorto-coronary bypass, percutaneous coronary angioplasty, myocardial infarction or acute coronary syndrome, 86% of patients are prescribed a platelet inhibitor, 63% a beta-blocker, 61% a hypolipidaemic agent and only 38%, an ACE inhibitor. The PREVENIR Study published in 2005 reported that only 12% of patients are prescribed the B.A.S.I.C. quadritherapy outside the acute phase. Despite recognised benefits in terms of survival, the B.A.S.I.C. approach is therefore clearly under-prescribed following coronary events.