New Strategy for the Secondary Prevention after Acute Coronary Syndrome Based on Cohort Studies

The treatment target for acute coronary syndrome has been changed from the life- saving to the secondary prevention, because the early reperfusion by the coronary intervention using stent as well as the anti-platelet therapy or statin treatment remarkably improve the short term clinical outcome. There are many evidences in terms of secondary prevention about dual anti-platelet therapy (DAPT) after stenting, statin use, beta-blocker, and so on, therefore their use is widely accepted; however, several issues remains unresolved in the real clinical practice. DPAT is a standard, but the duration of DAPT is not definitely determined. Beta blocker is widely used based on the evidence which was established before the introduction of reperfusion therapy and is not confirmed in the reperfusion era. Statin is widely used but its use is limited to control the LCL-cholesterol level, which is not applied to patients according to the fire and forget strategy followed by AHA/ACC guideline 2013. The target level of LDL-cholesterol is also different from European guideline. Clinical trials are not sufficient to resolve the clinical questions because of the variety of patients. Data based on the cohort study may answer the unresolved issue. In this symposium, we expect that new strategy for the secondary prevention will be proposed form cohort studies.