Unstable angina (defined as attacks that are increasingly frequent and/or prolonged, that occur at rest, or are brought on by trivial provocation) is one of the commonest reasons for emergency admission to hospitals in the UK. Even with appropriate treatment, the risk of myocardial infarction (MI) or death may be as high as 10% in the first 6 weeks after its development.1,2 The mechanisms underlying unstable angina, and the role of the alternative treatments that are available, are better understood than when we reviewed the topic 8 years ago.3 Here we reappraise the management of this important condition.