The hallmark of unstable angina is its unpredictability. Studies using coronary arteriography, angioscopy, and serial reconstruction of the microanatomy all show that thrombosis at the site of ruptured plaque is important in the aetiology of unstable angina.' Episodes of silent ischaemia are more important than symptomatic ischaemia as contributors to total myocardial ischaemia burden. Around 70% of the ischaemic episodes in patients with coronary artery disease are not -associated with angina,2 but patients with exercise induced silent ischaemia have a similar prevalence of disease affecting the left main coronary artery and three main vessels to that, in patients with angina but a higher mortality.3Multivariate analyses showed that the presence of silent ischaemia in patients after admission to a coronary care unit was the best predictor of subsequent acute myocardial infarction or the need for angioplasty or bypass surgery.4 The prognostic importance of silent ischaemia in patients admitted to hospital with unstable angina prompted us to study the role of thrombotic and fibrinolytic process in these patients. Our goal was to determine whether these processes had a role in silent ischaemia detectable at rest but not induced by stress.
Patients and methodsWe studied 10 healthy volunteers, 22