Editorial
Management of unstable angina: what role intervention, ask the RITA-3 trialists?
| The first 150 words of the full text of this article appear below. |
Unstable
angina usually results from the rupture of an atheromatous plaque
within the coronary circulation, which provides a stimulus for platelet
deposition and thrombosis.1 If the thrombus is
subocclusive it produces intense regional ischaemia, expressed
clinically as unstable angina, and there is an ill defined risk of
progression to thrombotic coronary occlusion and myocardial infarction.
Chest pain is inevitable and treatment with opiates should not be
delayed. Nitrates and 
blockers are usually sufficient to correct
myocardial ischaemia but dihydropyridine calcium antagonists (nifedipine, amlodipine) should be avoided, particularly in patients who are not taking blockers.2
Because unstable angina is a thrombotic syndrome, treatment with
antithrombotic drugs can reduce the risk of myocardial infarction and
death. Thrombolytic therapy is unhelpful3 but three
randomised trials have confirmed the benefits of aspirin for improving
early prognosis.4-6 In one trial, unfractionated heparin
was shown to have a similar beneficial effect, although there was no
clear
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