Risk stratification in patients with unstable angina is a major clinical problem with important therapeutic implications. Antiplatelet therapy is clearly effective in reducing the occurrence of myocardial infarction and death in this syndrome. Interventions including coronary bypass surgery and coronary angioplasty are frequently recommended for these patients, but the most appropriate application of these techniques needs to be further defined. After a brief discussion of the value of medical and interventional therapies, this review focuses on the clinical and noninvasive predictors of adverse events in unstable angina. An overall management strategy for these patients, based on current information, will be proposed.