What is a successful outcome in unstable angina ?
- Preventing a STEMI
- Preventing an NSTEMI ?
- Complete cure of angina and patient becoming pain free
- A negative stress test at 30 days
- Converting him/her into chronic stable angina subset ?
- Preventing recurrent ACS (Stable angina allowed >)
Achieving the above goal without a need a for PCI/CABG can be termed the ultimate success
- UA is the most heterogeneous group of CAD population. The mortality and morbidity widely varies. All of the above are therapeutic targets.
- One of them is converting them into a chronic stable angina patient, which imply the plaques are passified, stabilised, and the risk of future ACS is minimized.
- Further CSA patients are more amenable to longterm medical management.
- It can be argued avoiding a revascularisation procedure (PCI/CABG) by itself , could mean a success in the management of UA .
This is because any revascularisation (ie meddling with human coronary artery with metals or grafts) confers an added risk of future ACS* (Than a naturally stabilised UA) This is because, every future episode of angina in a post PCI or post CABG patient by definition becomes an unstable angina . Further , these patient’s lifeline is dependent on disciplined lifelong antiplatelet protocol.
* Post PCI/CABG patients are often under privileged care ! This may include pseudo emergencies due to non cardiac chest pain . This results in unnecessary 911 calls , admissions , inappropriate coronary care ,burden of check angiograms etc .This notonly increases the cathlab burden but also the economic burden of the nation’s ailing health resources.
Final message
It is suggested , the world cardiology community should consider ” attaining a medically manageable ” stable angina status is an acceptable therapeutic goal in patients who present with UA. This is because, the cost and consequences of eliminating angina in toto , in these patients may not be worthwhile and it is often futile or some times even fatal !
Dr.S.Venkatesan MD 