Recognition and treatment of unstable angina

Despite the growing number of patients discharged from hospital with a diagnosis of unstable angina, the diagnostic procedures and treatment of unstable angina are still greatly debated, as they have been for patients with myocardial infarction. In recent years the definition and classification of the clinical syndrome of unstable angina has been subjected to numerous proposals by distinguished cardiologists. An attempt to clarify and redefine practical guidelines for different subgroups of patients has been developed and carried out by the US Agency for Health Care Policy and Research (AHCPR). The current medical approach to treatment of patients with unstable angina is discussed in detail, analysing the role of antiplatelet medications, beta-blockers, nitrates, heparin and calcium antagonists. The small subgroup of patients with refractory unstable angina should undergo urgent coronary angiography and revascularisation. Previous and current research on medical treatment with thrombolytic therapy, GPIIb/IIIa platelet receptor blockers and direct thrombin inhibitors is outlined, keeping in mind one of the main aspects of pathophysiology of the disease, that is ongoing thrombus formation. In the future, a more aggressive strategy aimed at normalising the atherogenic lipid profile in this very high risk group of patients should be carried out, based on the positive results of lipid-lowering drug trials both in primary and secondary prevention.