Unstable angina: Invasive or conservative management strategy?

Acute coronary syndromes without ST segment elevation (Non-Q-Infarction and unstable angina) share a common pathophysiology, have no indication of thr ombolysis, and should not routinely be catherized on an emergency basis on admission. they should be put in bed rest, given anti-ischemic medications, aspirin and beparin. The small group of patients that do not stabilize wit h this medical regimen, should be catherized, in order to have revasculariz ation if they have the appropriate anatomy. There is nowadays a great contr oversy in the best management strategy for the larger group of patients tha t becomes stable after medical treatment installation. The invasive strateg y proposes early, routine coronary angiography, and revascularization when anatomy is appropriate. The conservative strategy proposes continued medica l treatment with invasive management only indicated by development of spont aneous or inducible ischemia. These two alternative strategies have been te sted recently in large, prospective, randomized clinical trials: there is n ot a definite answer, but the provisional guideline is that both are reason ably safe and effective.