Aims: Despite the guidelines, a treatment gap exists in the delivery of pharmacotherapy for secondary prevention. We aimed to analyze the trend in guideline-based medication usage following percutaneous coronary intervention (PCI) using the Melbourne Interventional Group (MIG) registry over a 6-year period (2005-2010). Methods: The MIG registry prospectively collects demographical, clinical, and procedural characteristics of consecutive patients undergoing PCI. We assessed medication use (aspirin, clopidogrel, ACE inhibitors, angiotensin receptor blockers, beta-blockers, and lipid-lowering agents) at 30 days and 12 months in patients alive and able to provide the information. Results: The cohort consists of 12,813 patients who underwent 14,787 consecutive interventional procedures. They comprised 76 males: 22 were elderly (=75 years), 23 had diabetes, 2 had severe renal impairment, 2 had severe left ventricular dysfunction, 26 presented with STEMI, and 44 of patients received drug-eluting stent. Follow-up was complete for 97.8 of the cohort at 30 days (2.2 mortality) and 89.1 at 12 months (4 mortality). From 2005 to 2010, the percentage of patients taking all five classes of medications increased each year. In 2010 at 30 days, nearly 60 of patients took all five classes of medications, and by 12 months, 75 of patients were taking four or five classes of medications. Conclusion: In conclusion, while the increasing use of cardiovascular medicines in an at-risk Australian cohort is encouraging, a treatment gap appears to still exist.