Progress in the diagnosis of unstable angina and perspectives for treatment.

Unstable angina is a high-risk phase of coronary heart disease defined by clinical symptoms. Electrocardiographic findings are heterogeneous and creatine kinase is only rarely elevated. However, troponin T and troponin I are found in about 30-40% of patients with angina at rest disclosing minor myocardial cell injury. Several studies in recent years have documented that troponins are the best markers to identify high-risk patients when other life-threatening, non-cardiac diseases are excluded. In addition, first evidence is provided that only these patients benefit from prolonged treatment with low molecular weight heparin or glycoprotein IIb/IIIa receptor blockers. Therefore, this new diagnostic potential should be made available to emergency rooms for risk stratification and in the future to guide therapeutic decision making.