Abstract:
Background. Unstable angina (UA), a type of acute coronary syndrome (ACS), needs prompt
care in patients with chronic obstructive pulmonary disease (COPD) due to high
complication risk. Coronary involvement is seen in 30–40% of cases, with 30-day mortality
reaching up to 30%, exceeding that of the general population.
Objective(s). The aim was to evaluate the treatment of UA in COPD patients, identifying
indicated and contraindicated drugs, to improve prognosis and specific clinical
management.
Materials and methods. This study is based on the analysis of scientific articles published
between 2020 and 2025, available in the PubMed database, clinical guidelines of the
European Society of Cardiology (ESC), and national clinical protocols (PCN-18, PCN-81),
offering a current and relevant foundation for the treatment of UA in COPD patients.
Results. The therapeutic drug classes used include selective beta-blockers (e.g., metoprolol)
preferred to avoid bronchospasm, and calcium channel blockers (e.g., amlodipine) which
promote coronary vasodilation. Nitrates (e.g., nitroglycerin) are administered early, at the
onset of chest pain, transitioning to intravenous form if symptoms persist. Oxygen therapy
is indicated to correct hypoxemia. Heparin is used in the acute phase, aspirin is
recommended for long-term thrombosis prevention, and clopidogrel may be added after
revascularization. Revascularization should not be delayed but should be tailored to COPD
severity.
Conclusion(s). The treatment of UA in COPD patients follows the general principles of ACS
management, emphasizing the use of selective beta-blockers, nitrates, calcium channel
blockers, antiplatelet agents, oxygen therapy, optimization of COPD therapy, and control of
risk factors (dyslipidemia, smoking, etc.).
