Risk stratification after myocardial infarction

Abstract

The optimal approach to risk stratification after myocardial infarction remains controversial. Early risk stratification is designed to identify those patients who may benefit from mechanical myocardial revascu-larization procedures or more intensive medical therapy to prevent early adverse outcomes. Use of exercise testing and noninvasive cardiac imaging to identify residual myocardial ischemia and left ventricular dysfunction in order to divide patients into high- and low-risk groups has gained increasing acceptance. Patients at high risk then undergo cardiac catheterization. There is also support for early cardiac catheterization to permit the rapid identification of patients who may benefit from mechanical revascularization. The challenge to physicians is to select the most accurate, safe, and cost-effective approach at their particular institution.