Unstable angina pectoris. What is the likelihood of further cardiac events?

Wide variation in severity of unstable angina requires an individualized approach. The goals are to stabilize the patient's condition and prevent progression to acute myocardial infarction or death. The following points summarize the current status of diagnosis and treatment: Patients suspected of having unstable angina but thought to be at low risk can be discharged after clinical evaluation if further outpatient evaluation within 72 hours is scheduled. Patients thought to be at intermediate or high risk should be hospitalized. Thrombolytic therapy should not be administered without evidence of acute myocardial infarction. Assessment of prognosis by noninvasive testing often aids in selection of appropriate therapy. Coronary angiography is appropriate in patients judged to be at high risk for cardiac complications on the basis of their clinical course or results of non-invasive testing. Coronary artery bypass grafting should be recommended in almost all patients with left main coronary artery disease and many with multivessel disease, especially those with left ventricular dysfunction. Percutaneous transluminal coronary angioplasty is also effective in selected patients. The discharge care plan should include continued monitoring of symptoms, appropriate drug therapy (including aspirin), and risk-factor modification.