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.
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 !