Medical Management of the Patient With Unstable Angina

Abstract

SINCE 1937, a clinical syndrome intermediate between stable angina pectoris and classic myocardial infarction has been recognized.¹This syndrome has been called a variety of names. Terms such as "preinfarction angina" or "impending myocardial infarction" unfortunately carry prognostic implications that may lead cardiologists and surgeons to precipitate action that may not be warranted. Other terms that have been used include "intermediate coronary syndrome," "accelerated angina," "crescendo angina," and "unstable angina." "Unstable angina" is the preferred term.² Unstable angina is not an isolated entity but is part of the clinical spectrum of ischemic heart disease. The vast majority of patients have extensive obstructive coronary artery disease similar to that found in patients with stable angina. Of 100 consecutive patients with unstable angina who were hospitalized in The Johns Hopkins Hospital coronary care unit and underwent arteriography, 94% had greater than 70% narrowing of at least one major coronary artery.