The need for coronary revascularization, whether emergency or elective, arises to a large extent from the limitations of currently available pharmacotherapy. This review addresses the roles for drug therapy in patients with stable angina and acute coronary syndromes (the latter including acute ST-segment– elevation myocardial infarction [STEMI]: thrombolysis vs percutaneous coronary intervention (PCI); and unstable angina pectoris [UAP] and non–Q-wave myocardial infarction [NQAMI]: antiaggregatory agents / anticoagulants / antianginals). Special consideration is given to therapies for severe or refractory angina (PCI vs traditional antianginals vs the newer metabolic anti-ischemic agents) as well as to the need to improve pharmacotherapy in conjunction with high-risk coronary angioplasty/stenting procedures to minimize early or late failure of these interventions...