[Rebuilding the concept of unstable angina]

Abstract

Large clinical trials provide invaluable information. This, combined with a number of small studies about the pathophysiology of certain diseases, permits us to re-consider previously accepted pathophysiological mechanisms and suggests an updated theory about the definition and diagnosis of individual diseases. This information obtained appears to place unstable angina in a new light. The instability of unstable angina seems to be the transient moment in which the previous clinical state is abandoned to pass into another clinical condition, rather than the establishment of a new diagnosis or nosological entity. Is this then the end of unstable angina as a final diagnosis?The development of troponin has increased our ability to identify myocardial necrosis. The myocardial ischemia leading to myocardial necrosis is the most important issue in atherosclerosis. In addition, immune cell activation may also relate to the extent of necrosis. The activation of the immune/inflammatory system in patients with acute coronary syndromes is probably not exactly related with the presence of an unstable plaque per se, as is usually inferred by inflammatory markers, but with the total atherosclerotic burden in the arterial tree of these patients. After all the new evidence of studies regarding coronary syndromes, is it not the time to reconsider the definition of unstable angina?