[Secondary prevention in patients before and after percutaneous transluminal coronary angioplasty: 5-year follow-up]

Several studies have demonstrated substantial risk reduction by risk factor modification in patients with established coronary artery disease. The number of studies investigating the implementation of risk factor intervention in clinical practice, however, is limited. We have, therefore, recorded drug use and cardiovascular risk factors in all 148 patients who had undergone percutaneous coronary angioplasty (PTCA) in 1989 at the University Hospital, Zurich, on hospital admission, after 6 months and 5 years later. Most patients had antithrombotic treatment with little change over time (78%, 87% and 83% on admission, after 6 months and after 5 years respectively, p = 0.27). The use of beta-blockers decreased moderately after 5 years (73%, 81% and 61% respectively, p < 0.01). Calcium channel blockers were used frequently without significant change in the follow-up period (56%, 50% and 46%, p = 0.25). Five years after PTCA, 91% of patients with a history of hypertension were on antihypertensive drugs. The use of lipid-lowering drugs increased markedly (5%, 16% and 33% respectively, p < 0.01). However, only a small proportion of patients qualifying for lipid-lowering drugs according to Swiss guidelines were treated. The proportion of current smokers decreased from 26% on hospital admission in 1989 to 12% in 1994. We conclude that in our study population secondary prevention was generally satisfactorily implemented. However, better monitoring and treatment of increased lipid levels is mandatory.