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Unstable angina: current concepts of pathogenesis and treatment Ambrose JA; Dangas GArch Intern Med 2000[Jan]; 160 (1): 25-37During the past 15 years, we have learned an enormous amount about the pathogenesis and treatment of unstable angina. In most cases of unstable rest angina, the pathogenesis is a mural thrombus formation on a ruptured or eroded atherosclerotic plaque. However, any process that acutely changes the supply-demand ratio (decreased supply or increased demand in the presence of a decrease in supply) can precipitate the clinical presentation of unstable angina. Standard acute antithrombotic drug therapy is effective in decreasing progression to infarction. Newer agents (low-molecular-weight heparin and platelet glycoprotein IIb/IIIa inhibitors) are more effective, and their use is evolving. Percutaneous intervention and bypass surgery can reduce symptoms and multiple hospitalizations, in most cases without a decrease in the long-term mortality rate. Because the cost of hospitalization is extremely high and the clinical presentation and outcome are heterogeneous, better triage methods are required.|Angina, Unstable/classification/diagnostic imaging/drug therapy/*physiopathology/surgery/*therapy[MESH]|Coronary Angiography[MESH]|Fibrinolytic Agents/*therapeutic use[MESH]|Humans[MESH]|Myocardial Revascularization/*methods[MESH]|Prognosis[MESH]|Severity of Illness Index[MESH] |
