Are Hospitalizations for Percutaneous Coronary Procedures Missed Opportunities for Teaching Rules of Secondary Prevention?

Background and aims: Percutaneous coronary intervention (PCI) is the most frequently used revascularization approach, often repeatedly applied. The quest for the ultimate revascularization procedure however may capture cardiologist’s attention and lead them to minimize the issue of secondary prevention in their patients. Aims of this study were to assess: 1. The individual risk factor profile, 2. The relation between the risk factors correction and the number of hospital admissions for elective procedures, 3. The appropriateness of medical treatment in patients admitted for elective coronary invasive procedures (diagnostic and interventional). 4. The patients knowledge of threshold values for cardiovascular risk factors. Patients and Methods: 100 patients (71% males, mean age 68 years) consecutively admitted for elective coronary angiography or PCI. They underwent a classical risk factors assessment and were divided in three groups according to the number of admissions for coronary angiography and in two groups according to the number of PCIs. Results: Fifty-seven % of patients had been previously admitted for invasive examination at least three times and 58% had already been treated with at least one PCI. Seventyone % were treated with beta-blockers but only 25% of them received a dosage found effective in RCTs (randomized clinical trials). Sixty % were treated with ACE-inhibitors and 83% received the dosage found effective in RCTs. Fifty-two % were treated with statins and 95% received a dosage found effective in RCTs. Nine % were still active smokers. Fourtynine % had a LDL cholesterol level above 100 mg/dL. The percentage of patients not on target was unrelated to the number of hospital admissions for invasive procedures. Conclusions: Modern cardiology is quickly embracing high tech procedures and trials results but often fails to spend enough time teaching how to control risk factors according to the recommendations of the evidence-based guidelines, even independently of the number of hospitalizations for invasive cardiovascular procedures.