Finding the High-Risk Patient With Coronary Artery Disease-Reply

OVER the years, many clinical studies have been reported that relate clinical, angiographic, and hemodynamic variables to prognosis in the patient with coronary artery disease.1-4The complications of coronary disease considered to constitute bad prognosis vary and include congestive heart failure, myocardial infarction, and death, as well as reversible end points such as the development of life-threatening arrhythmias, unstable angina, and angina requiring bypass surgery. These studies have been both retrospective and prospective and have identifed a number of clinical and laboratory variables related to the selected prognostic end points, first in a univariate and then in a multivariate analysis. This allows subdivision of the patients into high- and low-risk groups, relating risk to the morbidity and mortality achievable by medical treatment of patients with coronary artery disease. Because coronary atherosclerosis progresses with time, whatever risk stratification is done should be periodically repeated. The interval depends on whether there