Early percutaneous revascularization in patients with unstable angina. Current results and comparison with conservative medical treatment

In patients with ongoing angina, despite optimal medical therapy, the best therapeutic alternative is coronary angiography followed by emergency coron ary revascularization with surgery or angioplasty. However, whether or not all patients should have early angiography and revascularization is a matte r of debate. This paper reviews the advantages of modern medical therapy in this setting and the problems associated with early coronary revasculariza tion. In particular, it analyses the data from the main clinical trials tha t have specifically compared an early invasive procedure with a conservativ e strategy in unstable coronary syndromes. Finally, it assesses the impact of the new antithrombotic agents, such as glycoprotein IIb/IIIa receptor bl ockers, particularly during coronary percutaneous interventions. The data r eviewed suggest that early invasive intervention should be reconsidered, an d that patients should be controlled (if possible) under medical treatment until non invasive stratification tests allow the identification of those p atients who would benefit most from revascularization.