Re-evaluating risk factors for periprocedural complications during percutaneous coronary intervention in patients with unstable angina/non-ST-elevation myocardial infarction: who may benefit from more intensive antiplatelet therapy?
OBJECTIVE
Controversy regarding the optimal antiplatelet/antithrombotic regimen indicates a need to re-evaluate the place of these agents in treating patients with unstable angina/non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention.


RESULTS
Although clinical trial data suggest that glycoprotein IIb-IIIa inhibition benefits moderate-risk to high-risk patients, recent studies question the use of intensive antiplatelet therapy in lower risk patients. The resultant shift towards less intensive alternative regimens raises questions about identifying patients in whom an alternative strategy is preferable. The concept of risk stratification for coronary intervention has evolved from lesion-based categorization to include clinical factors, for example, elevated levels of cardiac troponin.


CONCLUSIONS
Risk factors for periprocedural complications during percutaneous coronary intervention can be divided into anatomic (unprotected left main stenting, bifurcation lesions, and diffuse disease) and clinical (older age, diabetes, renal disease, left ventricular function, recent myocardial damage, and female sex) factors. These may interact additively or synergistically, increasing the likelihood of complications in patients who might otherwise have been considered at low risk. We need to reconsider, therefore, how we identify appropriate options and, hopefully, optimize clinical outcomes. This review evaluates risk factors for periprocedural complications in an effort to determine patients who may benefit most from intensive antiplatelet regimens.
Cohen
Marc
M
Division of Cardiology, Cardiology Fellowship Training Program, Newark Beth Israel Medical Center, Newark, New Jersey 07112, USA. marcohen@sbhcs.com
Ferguson
James J
JJ
D000789:Angina, Unstable / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D000925:Anticoagulants / Q000008:administration & dosage; D006629:Hirudins / Q000008:administration & dosage; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D010446:Peptide Fragments / Q000008:administration & dosage; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012307:Risk Factors
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; C074619:bivalirudin