Risk Stratification in Unstable Angina: How to Select Patients Who Need Emergency Revascularization

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Abstract
Patients considered to have unstable angina have a varying prognosis depending on their clinical presentation. Prognosis can be influenced by several factors including persistent pain, transient ST segment shifts, left main coronary artery stenosis, and silent myocardial ischemia. Most patients who present with unstable angina have their symptoms controlled initially with pharmacological management. If symptoms persist, coronary angioplasty or heart surgery can be performed but morbidity and mortality is slightly higher than in patients who are stable. Patients who will benefit from early revascularization include those with persistent myocardial ischemia as manifested by spontaneous angina, spontaneous ST segment shifts on ambulatory ECG, a positive exercise test at a low cardiac workload, or a markedly positive radionuclide or cardiac ultrasound imaging test.