Several prospective randomized studies of medical or surgical therapy have not shown that either form of management alone is uniformly superior with respect to mortality for unstable angina pectoris. Patients managed medically have a greater incidence of angina pectoris. Earlier studies indicated a higher rate of nonfatal myocardial infarction with urgent surgery. Present management includes hospitalization and early intensive medical therapy with nitrates and, usually, beta-blocking agents. Coronary arteriography is advised within a few days. If the patient has left main coronary artery disease or three-vessel disease, early coronary artery bypass graft surgery within days to a couple of weeks is advised. Otherwise, medical management is advised and elective surgery can be performed if the patient remains symptomatic.