Unstable Angina Pectoris: An Interventional Approach to Management

The therapy of unstable angina has changed consider-ably in the last 15 years. An improved understanding of the pathophysiology has led to many of the changes. Thrombus, platelet activation, progression of athero-sclerosis, and coronary vasospasm all appear to have a role. Initial management in unstable angina should begin with aggressive medical therapy with nitrates, calcium antagonists, beta blockers, and aspirin. In patients who are refractory to aggressive medical management, early cardiac catheterization and coronary arteriography is in-dicated. The literature appears to confirm that patients with unstable angina who are stabilized with aggressive medical therapy fare as well as those treated with emer-gency bypass surgery. Percutaneous transluminal coro-nary angioplasty (PTCA) is the treatment of choic