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Is converting unstable angina into stable angina a therapeutic success ?

Posted Jan 15 2010 8:42pm

What is a successful outcome in unstable angina ?

  • Preventing a STEMI
  • Preventing an NSTEMI ?
  • Complete cure of angina and patient becoming pain free
  • A negative stress test at 30 days
  • Converting him/her into  chronic stable angina  subset ?
  • Preventing recurrent ACS (Stable angina allowed >)

Achieving the above goal without a need a for PCI/CABG can be termed the ultimate success

  • UA is the most heterogeneous group of CAD population. The mortality and morbidity widely varies. All of the  above are therapeutic targets.
  • One of them is converting them into a chronic stable angina patient, which imply the plaques are passified, stabilised, and the risk of future  ACS is  minimized.
  • Further CSA patients are more amenable to longterm medical management.
  • It can be argued avoiding a revascularisation  procedure (PCI/CABG) by itself  , could  mean a success in the management  of UA .

This is because any revascularisation (ie meddling with human coronary artery with metals or grafts) confers an added risk of future  ACS* (Than a  naturally stabilised UA) This is because,  every future episode of  angina in a post PCI or post CABG patient  by definition becomes an unstable angina . Further , these patient’s  lifeline is dependent  on disciplined lifelong antiplatelet  protocol.

* Post PCI/CABG patients are  often  under  privileged care ! This may include pseudo emergencies due to non cardiac chest pain . This results in    unnecessary 911 calls , admissions , inappropriate coronary care ,burden of  check angiograms etc .This notonly  increases the cathlab burden but also  the economic burden of the  nation’s  ailing health resources.

Final message

It is argued the world cardiology community, should consider attaining medically manageable , stable angina status is an acceptable therapeutic goal in patients who present UA. This is because,  the cost and consequences  of eliminating angina in many of these patients is not worthwhile and it is often  futile or some times  even fatal !

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