[Angioplasty in unstable chest angina. Angioplasty in unstable angina].

Angioplasty in acute coronary syndromes without ST elevation (angina + non Q wave infarction) is traditionally associated with an increased risk of major cardiac complications compared with angioplasty in stable angina. The recent development of instrumental techniques, in particular the introduction of stenting and pharmacological support for angioplasty have transformed the immediate prognosis in unstable angina. Consequently, angioplasty has become better tolerated and more easily recommended. Angioplasty cannot be considered without active medical therapy, including aspirin, betablockers, and non-fractionated or low molecular weight heparin, the use of the only inhibitor of GP IIb/IIIa receptors available in France, abciximab, remaining limited to the pharmacological environment of angioplasty in the absence of governmental authorization for its use in other indications. In high risk clinical situations, refractory angina, angina complicated by ventricular arrhythmias, left ventricular failure, mitral regurgitation, patients with a history of infarction or coronary bypass surgery, the indications of angioplasty and revascularization should be liberal as the prognosis of this patient group is improved. In situations of intermediate or low risk, there is no consensus about the best strategy, systematic or elective invasive procedures, that is to say guided by residual or recurrent myocardial ischaemia after initial stabilisation. However, the most recent trials, in particular FRISC II, seem to prove that systematic invasive procedures after stabilization by medical treatment, have a favourable influence on the prognosis compared with a conservative strategy. Other on-going trials may provide a definitive answer to this very controversial question.