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(Circulation. 2002;106:11.)
© 2002 American Heart Association, Inc.

Editorial

And the Answer Is, It Doesn’t Much Matter

David R. Holmes, Jr, MD; Bernard J. Gersh, MBChB, DPhil

From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn.

Correspondence to David R. Holmes, Jr, MD, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail dholmes@mayo.edu

Key Words: Editorials • angioplasty • stents • surgery

An extract of the first 250 words of the full text is provided, because this article has no abstract.

There has been widespread interest in defining optimal treatment strategies for patients with unstable angina. Within the penumbra of this diagnosis is a wide spectrum of patients, ranging from those with non–ST-segment elevation myocardial infarction to those who have had recent onset of progressive angina without electrocardiographic changes or evidence of myocardial necrosis. A great deal of interest in the former group of patients has been stimulated by the most recent trials, Fragmin and Fast Revascularization During Instability in Coronary Artery Disease (FRISC II), Validation of Immediate angioplasty in Non–Q-wave myocardial infarction: an Open randomized multicenter study (VINO), and Treat Angina With Aggrastat and Determine Costs of Therapy With Invasive or Conservative Strategies (TACTICS),^1–4 which support an aggressive approach for the majority of patients. Seventy-five percent of the patients in the TACTICS trial fell into the categories of intermediate or high risk on the basis of the TIMI grading system, and in these subsets there was a clinically significant improvement in outcomes in the invasive arm, a finding heartily applauded by interventional cardiologists.

See Circulation. 2002;105:2367–2372

Nonetheless, it should be emphasized that a sizable minority of patients with a history strongly suggestive of unstable angina have neither ECG changes nor elevated serum biomarkers, and in these subgroups the benefit of an aggressive approach is less evident. Although percutaneous coronary intervention has frequently been used in this group of patients, it has not been without problems, with the potential for increased complications particularly when angiographic thrombus was present.⁵ In addition, during . . . [Full Text of this Article]

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