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Epilogue: What Do Clinicians Expect From Imagers?

TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, and Department of Medicine, Harvard Medical School, Boston, Massachusetts.

View larger version (53K): [in a new window]   Figure 1 Risk stratification in coronary disease. The standard risk stratification allocates subjects to low-, intermediate-, and high-risk categories. High risk is traditionally considered to be >2% per year. However, since such patients may also include those at very high annual risk (>15%), the latter deserve to be placed into a separate category. Identification of a very-high-risk category will require development of imaging techniques aimed at the detection of unstable coronary plaques.

View larger version (32K): [in a new window]   Figure 2 Proposed algorithm for the detection of plaques likely to result in acute coronary syndromes. After the initial stratification into low-, intermediate-, and high-risk categories, using the Framingham risk score (FRS) and defined by the estimated event rate per year, identification of patients at very high risk will need development of tests that characterize vessel wall and identification of vulnerable plaques (VP), not simply luminal obstruction. Inter = intermediate; F/U = follow-up; V. = very; New Rx = new treatment modes.