Identification of intervention patients at increased risk

Many patients who once would have been classified as being at high risk are now deemed candidates for interventional cardiologic procedures. Definitions of risk thereby warrant reconsideration. Although the angiographic characteristics of lesions clearly identify patients at increased risk of adverse outcomes after angioplasty, important components such as thrombus may go unrecognized. Angioscopy provides a more precise means of identifying thrombus, but its use is not feasible in all patients scheduled for angioplasty. A triage system developed on the basis of clinical criteria is therefore desirable. Prospective data have suggested that the degree of risk is high in patients with unstable angina (particularly when refractory to medical therapy) and those who have recently undergone successful thrombolytic therapy for myocardial infarction. After stent implantation, patients who receive full anticoagulation therapy are at high risk of bleeding and subacute thrombosis, which may lead to myocardial infarction. New preventive strategies are required to optimize outcomes in patients with clinical characteristics indicative of high risk.