Scientific advances in cardiovascular research during the last decades have afforded effective pharmacological treatment to those surviving their first acute myocardial infarction. This secondary prevention treatment, based upon the combined administration of statins, aspirin, beta-blockers and renin-angiotensin blockers, might avert great part of the relapses contributing substantially to the overall incidence of acute coronary syndromes in the general population. However, a treatment gap separates evidence-based recommendations from their daily clinical application, a condition frequently explored even in the Italian medical setting. However, a general overview of the problem is missing insofar, a contribution that might eventually help to improve the status of secondary coronary prevention in our national environment.