And the answer is, it doesn't much matter.

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–STsegment 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.