Early Invasive Versus Conservative Strategies in Unstable Angina Pectoris Role of Prognostic Risk Factors

Abstract

Unstable angma IS an acute coronary syndrome caused by acute transient subtotal coronary occlusion. It is one of the most common causes of coronary care units admission and represents the most common cause for hospital admission. The syndrome is b.elieved to be precipitated mostly by a thrombus on top of a disrupted atherosclerotic plaque. Other mechanisms that may play a role are focal artery spasm, microembolization of platelet aggregates, critical atheromatous narrowing without thrombus or restenosis after coronary intervention. The disease is presented in variable clinical forms with variable severity and is associated in some cases with an increased risk of sudden cardiac death, fatal or non-fatal myocardial infarction. Therefore, It is very important to stratifY patients with unstable angina in order to predict the relative risk of major adverse cardiac events. This risk stratification depends mainly on some clinical and some laboratory data such age, some atherosclerosis risk factors(as diabetes), some clinical symptoms and signs, certain ECG changes, and specific cardiac enzymes. Treatment of unstable angina consists of either early conservative treatment in the form of anti-anginal and anti-thrombotic agents (including GP lib/lila antagonists) or early interventional therapy in the form of coronary angiography and subsequent PC!or CABG. The choice of either line of therapy depends mostly on the clinical risk score of the patient as well his response to initial therapy.