Only fools will manage unstable angina medically !That was exactly the statement , one popular Interventional cardiologist told a small gathering in one of the weekly meet . Do you agree ? Answer We can’t make a blanket statement like that . We have clear guidelines (Of course as licensed and certified cardiology practitioner you have every right to violate it !) . UA is risk stratified in Low , Intermediate and High risk categories .Only high risk group require emergency Intervention .Even in high risk group there are some reservation.(ICTUS study ) There are some very mild forms of UA (High grade stable angina precipitated by an emotional stress will exactly mimic UA. Similarly most secondary UA due to tachyardia , Anemia etc should not cause an alarm .) *Please note , currently coronary angiogram is included in medical investigation in most patients with UA . The confusion in interpreting such statements is partly because many physicians/ cardiologists consider doing a coronary angiogram by itself an Interventional management Reference
- de Winter RJ, Windhausen F, Cornel JH, et al. Early invasive versus selectively invasive management for acute coronary syndromes. N Engl J Med 2005; 353:1095
- Damman P, Hirsch A, Windhausen F, et al. 5-year clinical outcomes in the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial a randomized comparison of an early invasive versus selective invasive management in patients with non-ST-segment elevation acute coronary syndrome. J Am Coll Cardiol 2010; 55:858.
Dr.S.Venkatesan MD 
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