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Schweiz Med Wochenschr. 1997 Feb 15;127(7):254-60.

[Secondary prevention in chronic coronary heart disease].

[Article in German]

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Medizinische Klinik, Stadtspital Triemli, Z├╝rich.


To assess the quality of secondary prevention in patients with known coronary artery disease (CAD) we analyzed prospectively 278 consecutive patients on admission who were hospitalized for acute coronary syndromes (infarction 46%, unstable angina 54%). CAD was known in 155 patients (110 males: acute myocardial infarction 50, unstable angina 105; history of infarction 55%, chronic angina 41%, after CABG 13%, after PTCA 7%, coronary stenoses on angiography 6%). In these patients, aspirin was being administered in 58%, anticoagulation in 12%, betablockers in 43%, angiotensin converting enzyme inhibitors (ACEI) in 20%, and lipid lowering agents in 12%. Calcium blockers were given in 40% (nifedipine 8%). Patients with previous invasive diagnosis and treatment were more frequently treated with drugs of proven prognostic benefit than patients after myocardial infarction and patients with angina only, while overall cardiovascular treatment was similar. The respective rates of treatment were: for aspirin 78%, 60% and 39% respectively (p = 0.0005); for betablockers 59%, 46% and 24% (p = 0.004); for lipid lowering drugs 27%, 7% and 4% (p = 0.002). 12 of 19 patients with known congestive heart failure had ACEI. Only one fourth of dyslipidemic patients had lipid lowering drugs. We conclude that the prevalence of secondary prophylaxis in patients with known CAD is too low despite proven benefit, invasively treated patients having better prophylaxis.

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